HomeMy WebLinkAboutCLE201200064 Legacy Document 2012-04-04Application for Zoning Clearance
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CLE# 20IZ_ 64—
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check# 06r% Date: O `ZZ- iZ
-Z2
Receipt # No 29Z1 Staff:
PARCEL INFORMATION
Tax Map and Pa`rcParcel: C_��J5 [ Pa, 4-- a w 5-5E'Q � � •' Existing Zoning
Parcel Owner: t A ol- M P- ,rlI =► � (�C me(-
Parcel Address: r,<D J I e,(X41ev- CY-0 City e-i- State Jo— Zip 2-x`33
(include suite or floor) L' C }�• Z, OU
PRIMARY CONTACT
Who should we call /write concerning this project? ttam
r Q, L D
Address: �),;) Q a S�P , City C V-�(L,� O-Reg � S 0 eState U Zip ZZ9 0 1
Office Phone: 43L4) 2� , -- 0 I ;' Cell # Fax # 434- 7-9 "1 E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: P,'
Previous Business on this site
Describe the proposed business includingjuse, number of employees, number of shifts, avaigable parking spaces, number of
vehicles, and any additional information that you can provide: LA � 0 e- S `6 a� - 2. a - � le
C7_ d.Cu q a rm rr4N a ocL t-,, 1 n ,, 2RJC > Q L4e 00." QZQ !:� { S C Sr \OCR is
D-"\ & �h� �1 � - ::_ ? r v- - b ct.C.P� 0- - t -�
*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. j have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed S/ l'11---
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 _`¢ b (t
Zoning Official �1 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/N
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
Wil t ere 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 ublic water?
If private well, provide 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 septic or ublic sewer?
[;�, 3 -cam- \'L
D N `Qe, Mot. � Xb r t2rn0;(3-r S''Cn
Will you be p tting up a new sign of any kind? If so, obtarrr prop
Sign permit. U r-1 2-'5C)
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:
Square footage of Use: I j ,),
6) / N „
Permitted as: '4 ej, C-4 Ot � � clC-
Under Section: ?u
Supplementary regulations section:
Parking formula:
Required spaces:
Y/
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
- °/ N
If so, List: , ,
Proffers:
Y N
If so, List:
Variance:
Y /lO
If so, List:
SP's:
Y /(N)
If soc' nst:
Clearances:
SDP's
got 1)4
Revised 7/1/2011 Page 3 of 3
Sublet Premises
01 IJ
L7
FLOOR FLAN
5c.qz vw -11 -0.
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--------- t'JCISTING PARTITION
PARTITION TO Cars R1540YED
MM PARTITON
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NOTE
1. ALL EY,ISTIMS EGRE2515 FATTe?H5 TO RENAIH
2. FIHA VERIFY ALL EA57INS ccMTION5.
5. MOAIFY THE DQSTMb FIRE SLpPRESM SYSTI
rOR GObIf'LM. CaRRA'E.
h. PATCH AHD PAINT EX15TM6 YiALL.5 A5 NFLE5
it
`N
❑� 7
FLOOR PLAN
SG&E 1/8" = 11-O"
OLD TRAIL
ALBEMARLE COUNTY,
VIRGINIA
JONES
JONES
ASSOCIATES
ARCHITECTS
24 NOV 200Q
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, t A czme - o,,
A n [County application name an number]
was provided to ma r c,�- iv. 4 , ro r-�l�. L-L the owner of record of Tax Map
[name(s) of the record owners of the arcel]
and Parcel Number 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 ('flC1YC k
[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:
PO 6 U )C ��J C) C. rD']:�e,-+ \� C, -2-2-q32,-
[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
Print Applicant Name
Date