HomeMy WebLinkAboutCLE201500029 Legacy Document 2015-03-02Application for Zoning Clearance''
CLE # 2015 - 2.6I
OFFICE US
Z - n ' �J
PLEASE REVIEW ALL 3 SHEETS
Check # Date:
yy
Receipt # Staff-
PARCEL INFORMATION- n
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Tax Map and Parcel: �' t' I Existing Zoning r
Parcel Owner:— n �� �r(1�� ?�cry1'a_ '
Parcel Address: �� L� �'r(`cfLV�' iLcity `�f,t� } (' State ZiV2a 14 11
(include suite or floor)
PRIMARY CONTACT
ff
Who should we call/write concerning this project?
Address : 5'� /! o w ( A a Q;t,% c(ki),P__ City K S tAj I (,AL_ State VA Zip ZZ�i'4
Office Phone: �� Cell # Fax # E-mail 1'iClo a>rSrJnS 015h
APPLICANT INFORMATION
Check any that apply: of ownership of use __�LChange of name New business
Change ,Change
Business Name/Type: L_)1 `fir 1 \�1 ' t�1 lti'f'I �' 01
Previous Business on this siteaA 7' 11' `) ) �� 1I L
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: + 0 P-)n_ e
G / 'DC U CL A C4.4 r r+U
*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' rmission to use the space indicated on this application. I also certify that the information provided
is true and acc to the best of m knowl d . I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature �C� Printed 04nW �t'ltr S '
APPROVAL INFORMATION
as proposed [ ] Approved with conditions [ ] Denied
�Approved
] 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 A 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
�o fn
Intake to complete the following:
Y1(
Is UsD
Is us LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Yl
Will re 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 tha ies
Is parcel on rivate we t
If private we , rrovi e He e artment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel o septic or public sewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign �ePermit #� u
Y 4N J
Wil ere 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: Sby
O/N
Permitted as:4ii��i
Under Section: A • 2 7
Supplementary regulations section:
Parking formula -
Required spaces:
Y/
Items o be verified in the field:
Inspector Date:
Notes:
Viol tions:
Y/
If so, ist:
Proff s:
Y/
Ifs , ist:
Variance:
Y/0,
If so, ist:
Ftp,s:
/N
f 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 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]
the owner of record of Tax Map
and Parcel Number 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 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].
Date
ROBERT W. TUCKER. JR.
DIRECTOR OF PLANNING
Joice G. Payne
Route I,' Box 321
k • V' 22947
OF ALISzk
.�F .
. D�Ro1M�
Planning bepartment
804/296-5823
414 EAST MARKET STREET
CHARLOTTESVILLE. VIRGINIA 22901
December 27, 1978
RONALD S. KEELER
ASSISTANT DIRECTOR OF PLANNING
DONALD A. GASTON {
SENIOR PLANNER
N. MASON CAPERTON
PLANNER
i
i
Keswic , irgiiv.a - I,
Re: BOARD OF SUPERVISORS ACTION
Request for SP -78-69
Dear Ms. Payne:
This is to.'advise you that the Albemarle County Board of Supervisors at its
meeting December 20, 1978, approved your request for SP -78=69 subject to
the following conditions:
1. Virginia Department of -Highways and Transportation approval.of controlled access '
to 'the site;
•2. Staff approval of parking layout and landscaping;
3. No outdoor display of merchandise;
4. No auctions;
5. Approval of appropriate state and local agencies;
6. Sign sizes to comply with Article 18, Scenic- Highways...
Sincerely,
Jane Gloeckner .
Planning Department
J g/
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