HomeMy WebLinkAboutCLE201400221 Legacy Document 2014-11-19Application for Zoning Clearance
"} ° "�'
CLE # 2-014 --
-2-014Z2-1
�3; � a /�'
OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS
Check# 2-55-11 (P Date:
Receipt # _q_175 b Staff:
PARCEL INFORMATION
__ I
Tax Map and Parcel: �J n'1 {�� .- C1 ? Existing Zoning Ci 1
Parcel Owner: `�11 c-.e 12 ✓� L -L C..-
Parcel Address: q'10 CV-1'Y, i r- C'3 C-xA<- City yVlArlo�k5yi �1e- State
(include suite or floor)
PRIMARY CONTACT n_
� " I1'I
Who should we call /write concerning this project? , 1 >y� iZ^ `i 1 t1Y'S� S L')
Address: 1,S'p0 'V:;Cn e, L",-- City �4 (.rr , State 1 Zips �s
Office Phone: (�) 106 -Si ?6°t Cell # Fax 1330 E- mail.A Ar MA r'ksV"r,�,
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
n^
Business Name/Type:
Previous Business on this site.
Describe the proposed business including use, number of employees, number of shifts, available parking s ices number of
vehicles, and any additional information that you can provide: - ' $S
s s
*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 accurate to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature = _ Printed S. AcArwn &kn
APPROVAL INFORMATION
Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current lest data needed for this site. Contact ACSA, 477 -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:
¢— Date i I I f E f( `(
Building Official -.
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:
Y/N
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/N
Will there 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 o ublie wa er?
If private well, provide Heal epartment form.
Zoning review can not begin until we receive approval from Health
Dept, FAX DATE
Circle the one that applies - ---�
Is parcel on septic pu nc sewer?
Y/N
Will you be putting up a new sign of any kind?
Sign permit.
Permit #
If so, obtain proper
g)/ N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zonine to complete the following:
Reviewer to complete the following:
Square footage of Use: gl 'f
Permitted as:
Under Section: 20- .-Z - I
Supplementary regulations section:
Parking formula: /�
/� ,6
Required spaces:
Y/
Ite bl<n be verified in the field:
Inspector : Date:
Notes:
Viola ons:
Y/(y
If so, List:
Proffers:
Y /�Y
If so, List:
9 V riance:
/N
If so, List: //
SP's:
Y%(-D?
If so, List:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3
CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE ]LANDOWNER
Thls 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,_� -b �2 • taS�� r[ 1-T iii 6k M
[County appll6atron . name and number]
was provided to �C�2 C�-ii e ✓- L.Q-C --, the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number �o by delivering a copy of the application in the
manner identified below:
Hand delivering 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 .
✓ Mailing a copy of the application to (h \ e-C 1 LQ_ I� � L L C_
[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 to the following address:
Date
[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].
Signature of Applicant
J Aa r" aw
Print Applicant Name
JI //I
Date
0 1
h n
1 '
I
I
C-11
106
UP
JAN1
m6wwQ
+ 1 a
•..
�V
I1 Q�rM.�.•�•1•.�I''1�1.��—•.!
1,11.1 Ot6 V
I
i,
X11' •� .�" 1,' .
,
1
'.
GAS v
�
t
II
del
� -
•
(�iJi l�.Ip
�V Tlr�
• • M 111.-1 Ir11�
rlti�,
,
•
• � t • 11 I l r
•
�
/(�%/��J�)
r�r•11..O-MIrMYYI.I
II
•
1
. � w RL
1 •.a .. °rl
1 �A•IY •
1 1 1 • n/ r
A• /M A.iYYMe11Ary AryI+vY
■ Ir.l• 1 1111701 1 1
1 . 1 1 nTA 1 A
1 11 It•ii /41. IYe1nry
14AY. ,/ntY n• I ItY � A:/�/