Loading...
HomeMy WebLinkAboutCLE201400207 Legacy Document 2014-10-31Application for Zoning Clearance�11 /1Fy''� OFFICE US � Y PLEASE REVIEW ALL 3 SHEETS Check # Date: Receipt # Staff: PARCEL INFOR T 06 Tax Map and Parcel: - - -% Existing Zoning ' Parcel Owner: Parcel Address: ��C �L \� Q City Cr a l0VrCSUII State V j} Zip aaio J (include suite or floor) PRIMARY CONTACT ((11 Who should we call /write concerning this project? Address : ' a -TCV (��( City (asb©'o State U'12y' ZiP@DC26 0 Office Phone: (J�oj aob- j-I'a i Cell #1 Fax # E-mail C APPLICANT INFORMATION Check any that apply: Change of ownership Change of use of name New business —y�C-ha,. _nge Business Name /Type: �� \-1��i Y: iuoec -- ��SS�(�Q I Y 1 ao 1 Previous Business on this site Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of vehicles, and any additional information that you can provide: *This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move the use to a new location, a new Zoning Clearance will be required. I hereby certify that I own or have the owner's permission to use the space indicated on this application. I also certify that the information provided is true and a curate to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them. Signatur Printed `1 ��Lt iFC APPROVAL INFORMATION �x-] Approved as proposed [ ] Approved with conditions [ ] Denied [ ] Backflow prevention device and /or current test data needed for this site, Contact ACSA, 977 -4511, x117. [ ] No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing site plan. [ ] This site complies with the site plan as of this date. Notes: Building Official Date Zoning Official Date Other Official Date County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 Revised 7/1/2011 Page 2 of 3 Intake to complete the following: YIN Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Yf WiH ere be food preparation? If so, give applicant a Health Department form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that applies Is parcel on private well or- "q is wate If private well, provide Heal_th`De me;n i flo rm. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that appli. Is parcel on septic or ublic sewer? YIN Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # YIN Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # Zoning to complete the following: Reviewer to complete the following: Square footage of Use: Y/ N n Permitted as: AA ,o d i'[4 l C) � 1 t &. Under Section: -L L/ • 2 Supplementary regulations section: Parking formula: Required spaces: Y/ Items to be verified in the field: Inspector : Date: Notes: Violat'ons: Y/ If so, ' Vs Proffers: Y/ If soist: Variance: Y / QO If so, List: SP' Y If Bast: Clearances: SDP's Revised 7/1/2011 Page 3 of 3 CERTIFICATION THAT NOTICE OF THE APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER This form must accompany zoning applications (Home Occupation, Zoning Clearance, Zoning Administrator Determinations or Appeals, Sign Permits, Building Permits) if the application is not the owner. I certify that notice of the application, was provided to [County application name and number] [name(s) of the record owners of the parcel] and Parcel Number manner identified below: tf Hand delivering a copy of the application to the owner of record of Tax Map by delivering a copy of the application in the [Name of the record owner if the record owner is a person; if the owner of record is an entity, identify the recipient of the record and the recipient's title or office for that entity] on Date Mailing a copy of the application to [Name of the record owner if the record owner is a person; if the owner of record is an entity, identify the recipient of the record and the recipient's title or office for that entity] on Date to the following address: [address; written notice mailed to the owner at the last known address of the owner as shown on the current real estate tax assessment books or current real estate tax assessment records satisfies this requirement]. JPAA�-L unt 1J,T- g``nature of Applicant Print Applicant Name 4aq I 1� Date