HomeMy WebLinkAboutCLE201500024 Legacy Document 2015-02-18Application for Zoning Clearance_
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I'L;LASIi RE VIE, ALL 3 SHEETS
Check # Date: _
Staff:
Receipt #
PARCEL INFORMATION 1 1, Zoning�►Jl1�iS
Parcel: l0 l V�1 1 " A -10
Tax Map and _ -Existing
ParcelOrvnet; Flowers Baking Co.
Parcel Address. 360 Greenbrier Ave. City Char IottesvilSlEte VA Zip 22901
(include suite or floor)
PRIMARY CONTACT
Who should the call/write concerning this project?
Address • City State Zip
omee Phone: (_} Cell# Fax# E-mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of natne New business
BusinessNamelType: Flowers Baking Co Bakery, n,rtlet-
-----------------
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: Bakery Store Outlet 4 emlployeeS,
1 shift, 12 parking spaces in front 5 on 1 eft si He 7 on right-: sid-e
*This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move 0e use to a new location, a new Zoning
Clearance will be required.
I hereby certify that I own or have the ownces 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 dent, and that I will abide by them.
>♦, t--- Printed Debra Mutherspaw
�t,"�
Signature �
APPROVAL INFORMATION
} Approved as proposed [ ] Approved with conditions [ ] Denied
[ j 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 ai A,tnema t•te uepartmem oI l,vunn u+u�y �✓cr=,v,+.=_
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
Revised 7/1/2011 Page 2 of
lowe
Xntttice to complete the following:
Is u e in LI, HI or PDIP zoning? Ifso, give applicant a Certified
Engineer's Report (CER) packet.
y/, � No
Marc 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 Public Water
Is parcel on private well o ublic ter?
If private well, provide I iea rttnent form.
Zoning review can not begin until we receive approval from Health
Dept FAX DATE-
Circle
ATECircle the one that applies Pl i c S e r
Is parcel on septic or public sew
/ N Yes
ill you be putting up a new sign of any kind? If so, obtain proper
Sign permit. q
Permit #
Y/V
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
O._ ,t _-.!- --
Reviewer to complete the following:
Square footage of Use:
2,126
0/ N.
Permitted as: _ LiAlC3�✓X
Under Section:
Supplementary regulations section.
Parking formula: X)
Required spaces:
Y/
Items to be verified in the field:
Inspector
Notes:
Date:
Zvnii► iv Luiii ,V«
Violations:
Y/6N
If so, List:
Proffers:
so, List:
Variance:
IN
f so, List:
V4 ��` ChAj
SP's:
Y/
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.
This form Hurst accompany zoning applications (Home Occupation, Zoning clearance, Zoning
Administrator Determinations orAppeals, Sign Permits, Building Permits) if the appileation is not the
owner.
I certify that notice of the application,
[County application name and number]
was provided to Flowers Baking Co. the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number 061W0 -01-0h-00600 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
[Name of the record owner if the
if the owner of record is an entity, identify the recipient of the record a
office for that entity]
on
Date
to the following address:
.ord owner is a person;
the recipient's title or
[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].
u• - - r
Signature of Applicant
Print Applicant Name
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