HomeMy WebLinkAboutCLE201200072 Legacy Document 2012-04-04(1&6)
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Application for Zoning Clear lance
CLE # '2,O 12 - q 2-
OrFICE USE ONLY
3 4 �-
PLEASE REVIEW ALL 3 SLEETS
Check # Date:
Receipt # & 64 Z Staff: i' ,b
PARCEL INFORMATION] q
Tax Map and Parcel: D i ►:J I "� Existing Zoning Ott m jxChu�
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Parcel Owner: /
q4:,;5 G(evrwcxxi S Fr�-� (-�.► ,
Parcel Address: 5w +- (04- City Gkat.lr'l0i'"- o- 5VCI iC�State VA Zip.Z L
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project?
a43 C-v , �-
Address: u t -� G04:: City C' rIa�r k)A-�r(� [<-State VA- Zip Z2cjp
4-34-- 434 - Lee 9D (ee ��v�hc�s Ilov�faW.
Office Phone: ( ZC�2'g'i0> Cell # 11 Ot -OgS % Fax # 2-0Z- 'F?5 to E-mail C161M
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name (/ New business
Business Name/Type: L ( V l Vl . ` S k V2 Lo V1/' F( y' y-r-)
Previous Business on this site �DVVtis`�
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: L-a W Div VY) '° Mlle e�Mi2
rJ2LI—LWz' eim- PLoyeia.
*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 e best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature '� -�' (._� Printed
APPROVAL INFORMATION
j1 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 3
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
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, ZbVi M 3
[County application name and number]
was provided to L L--C- the owner of record of Tax Map
[name(s) ofthe record owners of the parcel]
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and Parcel Number �J �,r p (� (b by delivering a copy of the application in the
mariner identified below:
1/ Hand delivering a copy of the application to POV��
[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]
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
Le-e 6 V j , ,"- j v//
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Print Applicant (Name
AL 1
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Date
Intake to complete the following:
YIN
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
YIN
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�public wa e ?
If private well, provide Hea]�Dep ent form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic o u is sewer?
YIN
Will you be putting up anew sign of any kind? If so, obtain proper
Sign permit.
Permit #
YIN
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:
Square footage of Use: 9-7-5
YIN rr
Permitted as: 77 A t � C c--
Under Section: Z y 24 .
Supplementary regulations section:
Parking formula:
Required spaces: f J
Items o be verified in the field:
Inspector • Date:
Notes:
Violations:
Y/A
If so, ist:
Proffers:
YIN
If so, List:
7—mA Lob
Variance:
Y/A sov ist:
If so,
SP's:
If so, is Y /
t:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3
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