HomeMy WebLinkAboutCLE201100212 Application110TAMIT.A.Md
Application for Zoning Clearance
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check# �5%0 Date: 2 ZZ -1
Receipt # Staff: L
PARCEL INFORMATION --�
Tax Map and Parcel: Ac 1� Existing Zoning
Parcel OWllel': 1��1U y 1 Res
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Parcel Address: V�� �F �JF r -�s��, P1�� ? City CH ILC- 0— State Zip
(include suite or floor)
PRIMARY CONTACT nn
�4/Lt"2j U.-(
Who should we call /write concerning this project? ! r i F� 2C701�S —�IL -� F23tZt�✓_F
Address : 6 -? ➢e- cF1Z J £- eFf I �i"'`�. City C( S��L� State VA 7EpZ2�I ! f
-jiso ,,
Office Phone: Z4 G `z 3 o o Cell # Fax #K3`r Z96 -U 7ZZ E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business .
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Business Name /Type: G�RAJF}L�; 7�,✓F Q(z�.J9zt �(�
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:
f I 1arz�i,lr SDI S ! t yF µcuss
*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, tha ave the owner's permission to use the space indicated on this application. I also certify that the information provided
is true and ac c a too ne est of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed I F —1 DVS 11PMB02,
APPROVAL INFORMATION
1>,J Approved as proposed A pproved 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
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 7/1/2011 Page 2 of 3
Intake to complete the following:
Y
Is On LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y /
Wil 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
Reviewer to complete the following: I
Square footage of Use:
Y rmitted as: (y
Under Section: ZL a
Supplementary regulations section:
Circle the one that applies Parking rmula:
Is parcel on private well o ublic �ent `
If private well, provide Hea form.
Zoning review can not begin until we receive approval from Health Required spaces:
Dept. FAX DATE
Y/N
Circle the one that appli Items to be verified in the field:
Is parcel on septic or ublic sewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit # Inspector : Date:
�/ N Notes:
Will there be any new construction or renovations?
If so, obtain I pper Pertni� `
Permit # �(o l
'F� apqd 14 1(et i(
Zonin2 to complete the following:
Viol i s:
Y /(N )
If so, st:
^offers:
Y Y N
so, List:
Var'anc :
Y/N
If so, st:
Y/N
o, 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 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 � ,Oywj,4 )& `,y 1 w�—, the owner of record of Tax Map
[name(s) of the record 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
v Mailing a copy of the application to Lk 5A S �r�� S
[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 %1/1,97/11
Date
to the following address:
/J 2323 �
,L1szB�w curt S 3 �a l�t� c{�idrro`%_
[address; written notice mailed to the owner 2(t the last knowfi 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 Namd
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Date
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RICHMOND, VIRGINIA 23219 FACSIMILE 9D42M.0329
CHARLOTTESVILLE, VIRGINIA
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101 SH0OIOE SURTRIRD FLOOR TELEPHONE 804.648W4D
675 PETER JEFFERSON PARKWAY
RICHMOND, VIRGINIA 23219 FACSIMILE 9D42M.0329
CHARLOTTESVILLE, VIRGINIA
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