HomeMy WebLinkAboutCLE201200047 Legacy Document 2012-03-01for Zoning Clearance
isApplication
OFFICE USE QY
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PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Receipt # Staff: mwb
PARCEL INFORMATION
Tax Map and Parcel: 56A2 -1 Parcel 71B Existing Zoning H -1
Parcel Owner: J. BRUCE BARNES ' INC.
Parcel Address: THE SQUARE City CROZET State VA Zip 22932
F�j ol(include suite or floor)
PRIMARY CONTACT
T�OVhGtS M u vlSOl�
Who should we call/write concerning this
project?
Address: (%i I I3 City ( ro Zed State VA Zip
Office Phone: L_) Cell # gb 6'- �I R 3 I Fax # E -mail TbVhQ rrh rn 5h •eat,
APPLICANT INFORMATION
Check any that apply: Change of ownership _Change of use Change of name New, business
Business Name /Type: u h S oyi 1 S Se r yr ceS
Previous Business on this site + IJ r (,(C2 nj G< tykes -rot— 1 1'� �a h 1 lei
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: fiD GeSS1 Y�2 W O
0
*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 that I will abide by them.
(Jthem, nand
Signature .. Printed7l'k hJ -!C �'J. V ►' \ V/��f
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
v
Zoning Official 1�t/ Date 2� Z 2 %
Other Official Date
County, of Albemarle i)eparrmenr of Uomrnun,Ly yCVU1UFk11c1t�
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:
]Z)/N
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y OT
Will there 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
Is parcel on private well or ubhe wRer?
If private well, provide Healt epartment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that app'lie.
Is parcel on septic or ubR lic severe .
Y /O
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y /10
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
�_— 41-- 1'..11
Reviewer to complete the following:
Square footage of Use: &
(y7 / N •2� 00
Permitted as:
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces:
Y/
Ite o be verified in the field:
Inspector : Date:
Notes:
GOn1A tU (:U111 ieM Lac 1ViAV rr1II .
Violations:
Y/�
If so L st:
Prof s:
Y/
If so, List:
Varga ce:
Y/N
If so, List:
SP's:
Y /(Ns
If so, ist:
Clearances:
SDP's
•Z�oo�3� .
Revised 7/1/2011 Page 3 of 3
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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, op U ca-bov1 (�r Zoo;" C6Y-ance-
[County application name d number]
was provided to a r Y ((/V1 P1 A WA It the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number .56A2--( DrCe( 713 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
Date
to the following address:
[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].
Signature of Applicant
Trwrnas F-�- t"Iv u s OkA
Print Applicant Name
Date
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