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HomeMy WebLinkAboutCLE201500043 Legacy Document 2015-03-11Application for Zoning Clearance" CLE # 2.a 1S - • =» F hRcllsP' OFFICE USE ONLY PLEASE REVIEW ALL 3 SHEETS Check # In Date: _35/7 t Receipt #'19o -L--7 Staff: PARCEL INFORMATION Tax Map and Parcel: OLi 0o - 00 — 00g 0 (D Existing Zonin T1 Gl_G1 Parcel Owner: `) N - Z A N L �- C' �i Parcel Address:?. C5. IJOX °� 03G Cityl ck,(k C State \4 t(- c +(1 t CA, Zip 1210(' (include suite or floor) PRIMARY CONTACT Who should we call/write concerning this project? Address : 5 3 } S S (z w, (;k City _0\RCcfd State i 61 �h i C' Zip J `l Office Phone: Cell # �.�t(-L/ )_()-J ax # E-mail e6rd/ n - o N PGtc i 341- APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business /` Business Name/Type: C� ()� l�� Gti V �2 e S \% C� l0©�f - i' i �i i(�'� (�' l 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: *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 1146� A Printed br 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: Building Official Date r�r Zoning Official Date M/6 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 i� -(mMI N Intake to complete the following: Y/6 Is use in Ll, HI or PDIP zoning? Engineer's Report (CER) packet. If so, give applicant a Certified Y/ Will Oere 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 Parking formula: Is parcel on private well oris ter? If private well, provide Heali. partment form. Zoning review can not begin until we receive approval from Health Required spaces: Dept. FAX DATE Reviewer to complete the following: Square footage of Use: �-? (3F/N �/_ Permitted as: I/ "1—.d ) Under Section: ��� 2 • l Supplementary regulations section: Circle the one that applie Is parcel on septic or blic se r? Y/N Will you be putting up a new sign of any kind? Sign permit. Permit # Y/ Items to be verified in the field: If so, obtain proper Inspector : Date: Y / N Notes: Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # Zoning to complete the following: Violations: Y /�N If so, ist: Proffers: Y /?ist: If so, Variance: Al i If If ist: SP's: Y / If so, ist: 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, [County application name and number] was provided to JA- ZAN LLC [name(s) of the record owners of the parcel] the owner of record of Tax Map and Parcel Number 046134-00-00-00800 by delivering a copy of the application in the manner identified below: /Hand delivering a copy of the application to JA-ZAN LLC (JAY JESSUP) [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 JA-ZAN LLC (JAY JESSUP) [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 to the following address: P.O. BOX 9035 CHARLOTTESVILLE VA 22906 [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 rexWs satisfies this requirement]. J A n Date