HomeMy WebLinkAboutCLE201400238 Legacy Document 2015-01-12E: r'
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Application. for Zorna�,
CLE # D1 q DEC 2014
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OFFICE USE ONLY
PLEASE .REVIEW AI..I, 3 SHEETS Date: 212, 26 (�
PARCEL INFORMATI0,N. r
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Tax Map and Parcel: [;xisting Zoning
Parcel Owner:_ I 1 i,xm N_UY ft
Parcel Address: IC7! Ne�fnkh L,mlt S Lie city (!' QZ&A State % _Lip
(include suite or- floor) -2 Utz
PRIMARY CONTACT
Who should we call /write concerning this project? is I V6�r-e_ Z _•__
Address :1. 07 (NrN1 flOynN1 P Cl Ar) city c_y1oyyAo V 1:.»State �( Zip 22CLO 1
Office Phone: E-mail
APPLICANT INFORMATION
Check any that apply; Change of ownership Change of use Change of name New business
Business Name /Type: L.Gti JQN { 1-
Previous Business on this site �, W L it 7 Z
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
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vehicles, and any additional information that you can provide: j �,4�� '��(11�`�, U )')(A Q
*This Clearance will only be valid on the parcel for which it is approved. li'you change, intensify or move the use to a new location, a new Zoning
Clearance will be required.
I hereby certifj that I own or have the o\vner`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 rA\�3Ci1�C:2
APPROVAL INI+OR.MATION
[>' Approved as proposed [ ] Approved with conditions [ J Denied
[ Backnow prevention device and /or current test data needed for this site, Contact ACSA, 977 -4511, xl 17.
[ ] No physical site inspection has been done for this clearance. Therefore, it is not determination ofcompliance with the existing
site plan.
[ ] This site complies with t1w site plan as of this date.
Notes:
Building Official nave
Zoning Official �' G Date
Official Date V
County of Albemarle Deptartment of Community Development
401 McIntire Road Charlottesville, VA 22902 'Voice: (434) 296 -5832 Fax: (434) 972 -4124
RECEIVED
'Revised 7 /1/2011 Paget of3
DEC 292014
COMMUNITY
DEVELOPMENT
Intake to complete the followittl;:
YIN
Is use in L I, HI or PDIP zoning? Ifso; give applicant a Certified
Enginecr's Report (CER) packet.
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ill there be food preparation?
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from I °lealth
Dept. PAX DAT
Reviewer to complete the following;
Square footage of Use:
Permitted as: _ ih e.
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Under Section: !U T �� G, y �
Supplementary regulations section:
Circle the one that applies Parking formula:
Is parcel on private well or p tic watcl.9 s .Sr4,-
Ifprivate well, provide Health Dep tent form.
Zoning review can not begin until we receive approval from Health Required spaces:
Dept. FAX DA"1 F
Y/N V
Circle the one that applie \ Items to be verified in the field:
Is parcel on septic public sewer:
WN
you be putting tip a new sign of any kind? If so, obtain proper
Sign permit.
Permit # Inspector : Date;
N Notes:
flI there be any new construction or renovations?
If so, obtain the proper Permit,
Permit -4
Zoning to complete the followinLy:
Violations:
l) /N
If so, List:
Proffers:
AA IN
f so, List:
Variance:
Y /�
Irso, List:
S.P's:x�
Y /C%
If so, List:
Clearances:
SDP's r�/�/ .
/ X d
Revised 7/1/2011 Page 3 of
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CERTIFICATION THAT NOTICE OF T:C:I.E
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
This form must accompany zoning applications (Monte Occupation, Zoning Clearance, Zoning
Administrator Determinations or Appeals, Sign Permits, Buil(ting Permits) if the application is not the
otivner.
I certify that notice of' the application
[County application name and number]
was provided to J�t,.( 1.1 MOUV1At V ")gQ fszltF 5' LU _.._._.. the owner of record of fax Map
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[name(s) of the record owners of the parcel]
and Parcel Number �i i� _ U 1 00 00 0 6 O_by delivering; a copy of the application in the
man ler identified below: i
Hand delivering a copy of the application to i;(N U ,L>UN; NAUA ( i
[Name of the record owner if the record owner is a
person; if the owner of record is an entity, identify tale recipient of the record and the recipient's
title or office for that entity]
Oil ItM"q
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 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
Print Applicant Name
.Date