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HomeMy WebLinkAboutCLE201200053 Legacy Document 2012-03-0901001,11, Application for Zoning Clearance OFFICE U OIr `7 +5 PLEASE REVIEW ALL 3 SHEETS Check # Date: Receipt # Staff: PARCEL INFORMATION ff 10 Ci CQ C CC1'�1'Y1P,YY (— Tax Map and Parcel: 04,500— 00-00— Existing Zoning 1 a Parcel Owner: u0ofd br6e) k Q-%JCCCjeS LL6 , Parcel Address: '�-©1'J kj om 6zc6K lam- City ('h 4 r 64P-so State y A- Zip ZZ57,O) (include suite or floor) PRIMARY CONTACT Who should we call/write concerning this project? 6 i(.vr 1.a A Address: .1-01Z Woc5cj hrnc,, K L-i' City bla- f-I&l -1'z � Ile_. State V A Zip 22-001 Office Phone: S 6 -158 Cell # Fax # E-mail Cho r l eS 4D Char l cal es o j i le.- Sc>1i.-1- iar,Sw i°oYr1 APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business / ^ Business Name/Type: 0 -h ar leAA-e-s n , lie, 2�& ( E,56 k 5.n l u %i rM 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: `R &1 i �-1ya --il(ps n;-P;2± Cg-) "o ca f��6lnpl\.L �-SI 1.6tAr6 c'oae - };b •-k7 4Oa,b,ule Tlts.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'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 Printed Char te>S P... it Xi) . w-1 APPROVAL INFORMATION °Approved as proposed [ ] Approved with conditions [ ] Denied [ ] Baclflow 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 C Date 16 I 1 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 LI, HI or PDIP zoning? If so, give applicant a Certified Engin is Report (CER) packet. Y/ 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 o c w er? If private well, provide H epartment form - Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that applies Is parcel on septic or JK4blic sewer? Y/N Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Y/N Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # Zoning to complete the following: Reviewer to complete the following: J Square footage of Use: 7 y (0/N n Permitted as: u ,4 j I e�J d�-I 2 c. Under Section.. Supplementary regulations section: Parking formula: (� �vy �' Required spaces: Y / N L--� Items to be verified in the field: Inspector • Date: Notes: Viol ions: Y/0 If so, List: offers: �5/N If so, List: Varia ce: Y /CM. If so, List: SP' Y/ s: If 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 fora must accompany zoning applications (Hone 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, ZD h i rn !S C—I e a f u. h ce AQ1' 06o ej baoi -b [County application name and number] Charjp4Wj,, 11e- A 22.gv / was provided to U)0Qd brn n the owner of record of Tax Map [name(s) of the record owners of the parcel] and Parcel Number 0q W fib. -ix), Lo 9c..0 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 C ' 1 kS Q4 " Fun ) opar4I [Name of the record owner if the record owner iA a person; M A n V%Cje r 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 3I ! 1 I Z Date to the following address: [address; written notice mailed to-the owner at the last 161own 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"' G�u r I-e.5 F)7o ft Don vo!� Print Applicant Name Date CI- { \yf"w^n�l�� O