HomeMy WebLinkAboutCLE201500014 Legacy Document 2015-01-21Application for ZoningClearance
rr CLE # IM -14
OFFfCE UAVOP
1-2b-
PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Staff:
Receipt #
PARCEL INFORMATIION
bI g[ 4 2 - D
Tax Map and Parcel: Existing Zoning
/
Parcel Owner: Val & F:�- f��•
Parcel Address: 1 d y SNelk e VAL City la"V'j/ utate _ A- _ Zip2g 901
(include suite or floor)��
PRIMARY CONTACT
Who shouldwecall/write concerning this project?
Address: f . V • G City W A`yJ-� — State Zip7�O I i
Office Phone: (�20 sIo/ -7-6 Cell # 5*)—LZ?Qak # E-mail Pdxyl • 14WrtW 0- e- e...--
MA"tZro*jf+LCOUAL' iL tJG.Gdtould. toLM1
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change ofnameNew business
Business Name/Type: �Pr7TotiJ)r 0 U0SC-LrtJ & &P-10 UP , Z-iC • —?f4 - eau j&t`:ruct S�
- C
Previous Business on this site &VC4,0 W,ty--
Describe the proposed business including use, number of emplo ees number of shifts, available parking spaces, number of
vehicles, and any additional information that you can provide: ;,u X "V:ora1 1l ly, L°Ouwle,
se re;U&S . Ilv -Cr-AvA-K :k ;e-ee.�-
V&rlaus 1,pcs.t�.d«►+
*This Clearance will only be vale 1 on tl 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 Celli fy th, or ha wner's mission to use the space indicated on this application. I also certify that the information provided
is true ai curate to th t oi'm nowled e I ha read the conditions ofapproval, and I understand them, and that I will abide by them.
��
Signature Printed P`1- �ftl/� s¢G✓2ENG�L" %e� ZDI
Al -U?
APPROVAL INFORMATION
'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:
� r
Building Official C Date I�_
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/U201 1 Page 2 of 3
Intake to complete the following:
y/8 /8
Is us'c in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y / (fes
Will here be food preparation?
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from L-Iealth
Dept. FAX DATE
Circle the one that applies
Is parcel on private well o ubliter?
If private well, provide He -lth Dzp, tment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that ap.p•li
is parcel on septic o public sewe .
Y/N
Will you be putting up a. new sign orally kind? If so, obtain proper
Sign permit.
Permit #
Y/N
Will there be any new constriction or renovations?
If so, obtain the proper Permit.
Permit #
7 n +., rin+n +lin fnllnwina•
Reviewer to complete the following:
Square footage of Use: 6 6 C
y/N
Permitted as: LEI
Under Section: '�� '2-
Supplementary
Supplementary regulations section:
Parking formula: /
�j� IIS
Required spaces: 3
Y/N
Items to be verified in the Field:
Inspector :
Notes:
Date:
Violations-.
Y/a
If so, List:
Proff rs:
Y/l
If so, List:
Variaice:
Y / (iV)
If so, ist:
Y
SP'2ist:
If
Clearances:
SDP's___"_ �—
Revised 7/1/2011 Page 3 of
CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
This form must accompany zoning applications (Hone Occupation, Zoning Clearance, Zoning
Achninistrator Determinations or• Appeals, Sign Pernits, Building Perncits) if the application is not the
owner.
1 certify that notice of the application,
[County application name and number]
was provided to Veq A t- � � - "' °� the owner of record of Tax Map
[name(s) of the r- cord owners of the parcel]
and Parcel Number
manner identified below:
by delivering a copy of the application in the
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 -e4 A- 6/ (;
[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 ! ' ?i0to the following address:
Date /�
3S3S" C% Na6le. i OA4 ee,"I.S S-4re, V ;
[address; written notice mailed to the owner at the 1 •t 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
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Print Applicant Name
Date
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