HomeMy WebLinkAboutCLE201200049 Legacy Document 2012-03-09d e
Application for Zon'n Clearance 60A
CLE # X012 -T"
OFFICE us
PLEASE REVIEW ALL 3 SHEETS heck # "t`�t Date:, ' -12-
S taff:
PARCEL INFORMATION
Tax Map and Parcel:
Existing Zoning
Parcel Owner:_ 6b"& -, iM' ae ice ;�,� �1 ') ir�vl,� P• i��,.8
r
ParcelAddress.,&"I '4 -lid City J►l State-A Zip Z" 2UY
(include suite or floor)
PRIMARY CONTACT r-►
Who should we call/write concerning this project9 do &'%A r,�%,�,�� _ ,{ ✓ .
Address:- C n
� O .1� e�l� Z—!ge City .t, v. State .4, Zlp'2
Office Phone: Cell #q�ax # E-mail
INFORMATION
Check any that apply: Change of ownership Change of use Change of name +/- New business
i4wt� � c � teen 0,-, L fir,
Business Name/Type: C
Previous Business on this site lkr— &Aft ~, U-0 .tt
Describe the proposed business including use, number, of employ es, number of shifts, vallab a parking spac s, number of
vehlcles, and any aAitfonal information That yotl can provide: Vc' QKC� �� � -�" pe 1� —
*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 acc to ° t of my kno edge, i' have read the conditions of approval,,� and I understand them, and that I will abide by them.
Signs m Printed V2rtWAArl
APPRO17AL INFORMATION
�;4'Approved as proposed [ ] Approved with conditions [ J 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
f YEJGi c. ('�ry�v'C+v G�w
Other Official Date 67- S re, °�l� 5e ,,1(tl
vC !7 /j l
CounVof Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 9724126
Revised 7/1/2011 Page 2 of 3
t o
Intake to complete the following:
Reviewer to complete the following:
Y / N
Square footage of Use: ;,3 7 /
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
b/
Engineer's Report (CER) packet.
N
Permittedas: Cou �`� 65 Drz
N
there be food preparation?
Under Section: 16),
If so, give applicant a Health Department form,
Zoning review can not begin until we receive approval from Health
Dept. FAXDATE
Supplementary regulations section:
Circle the one L s
Is parcel on p ivate w or public water?
Parking formula:
Required spaces:
-
If private well, ide Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Y/N
Circle the one that applies
Items to be verified in the field:
Is parcel offoc or public sewer?
SDP's
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit,
Permit #
Inspector : Date:
Y / N
Notes:
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7...i...T 4n ,.,,,,,,1 + 416 n fnllnIX71" o
.�.... __- ---- ---- - ---- --
Violations:
Y/6
If so, List:
Proffers:
Y/
If so, lst:
Vari nce:
Y /�I�
If so','�ist:
SP's:��
1' /(1V J
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 for must accompany zoning applications (Home Occupation, Zoning Clearance, Zoning
Administ for Determinations or Appeals, Sign Permits, Building Permits) if the application is not the
owner.'
certify thallotice of the application,
[County
was provided to
[name(s) of th record owners of the parcel]
and Parcel Number
manner identified below:
rame and number]
the owner of record of Tax Map
delivering a copy of the application in the
Hand delivering a copy of the apple tion to
[Name of the record owner if the record owner is a
person; if the owner of record is an enti dentify the recipient of the record and the recipient's
title or office for that entity]
Oil
Date
Mailing a copy of the, applica onto \
[Name of the record
if the owner of record is a entity, identify the recipient of
office for that entity]
on to the following address:
Date
if the record owner is a person;
;ord and the recipient's title or
[address; writt notice mailed to the owner at the last known address of the o ner as shown on
the current re estate tax assessment books or current real estate tax assessment cords satisfies
this require
Signature of Applicant
'Print Applicant Name
Date