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HomeMy WebLinkAboutCLE201200083 Legacy Document 2012-04-30Application for Zoning Clearance CLE # 2612-8-3 OFFICE USLI O Y 4-( PLEASE REVIEW ALL 3 SHEETS Check # Date: Receipt # Staff: PARCEL INFORMATION 1P ta Tax Map and Parcel: C) to I -L. C) - O 3- OD- O 1 Existing Zoning C 0MZ Css of Parcel Owner: (larlolAe- sVt1le- BireaL, QSSaelo -lnn of LO-U-prS Parcel Address: S S O 44-11) Sa DJ,- �-C' • City �����lies�,l }e State V A Zip22 qC11 (include suite or floor) PRIMARY CONTACT 'ho ul Nveasll�c/ rite I Rconcerning this project? Michelle- mcr ny-) W o l � . . Address : -B.x 0423 city eherlpVesv,lLQ� State VA Zip22iuo Office Plione: ( q l_I - C A Cell # Fax # ©l)-44- E -mail m m a r ;tin n Qb 3emst-one. com APPLICANT INFORMATION Check any that apply: Change of ownership Change ofa Change of name New business Business Name /Type: lemstvnk- C- Xn9O -Pr Seru', Lz,$ , _11) c- d)b1A U"e'MMrie, � le �)mlt Previous Business on this site e- horic"R�:11C, Afe" L PL%06 D*, on SF Rz_aov(-S Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of tvehicles, and any additional information that you can provide: IT S ��rk �tUC Sr ax\ LW1 neSSeS_,y .b JS'1 nCSS CC-_.Wns 4M -5v") E *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 tt�he,1 best of my knowledge. I�have read the conditions of approval, and I understand them, and that I will abide by them. Signature f Imo""'- Printed�i iCheA IP_ (Y)O(' -ol-N 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. 1 l A ` /Zi /2a1v Zoning Official Date Other Official Date County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 tax: (434) 972 -4126 Revised 7/1/2011 Page 2 of 3 Intake to complete the following: Reviewer to complete the following: Y / N I Square footage of Use: Is use in LI, HI or PDIP zoning? If so, give applicant a Certified ' Engineer's Report (CER) packet. /?)/ N / `]]ssennitted as: l �✓ ��)� -�� C Y Will Here be food preparation? Under Section: If so, give applicant a Health Department form. Zoning review can not begin until we receive approval from Health Supplementary regulations section: Dept. FAX DATE Circle the one that applies Is parcel on private well o ublic wat . If private well, provide Health 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 public sewer? Y, N Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Y Will t sere be any new construction or renovations? If so, obtain the proper Permit. Permit # Zoning to complete the following: Parking formula: ;oL- bb� Required spaces: Y/ Items o be verified in the field: Inspector : Date: Notes: Violations: Y/c Ifs , �����i```"st: Proff rs: Y/ If so, ist: Varia ce: If/ If so, ist: SP's: If/ Ifs 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 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, [County application name and number] was provided to ChQflz1- \'J,I of the owner of record of Tax Map [name(s) of the record owners of the parcel] TIWT-Cl and Parcel Number OLg 1 Z 0-03 -CO- 011 A O by delivering a copy of the application in the manner identified below: Hand delivering a copy of the application to Ph-)Lne- G oxAn ezr , CEO [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 to the following address: Date [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]. Si nattlre of Applicant licant g Mchd)e- E, M f D c, Print Applicant Name �4I►--�112- Date' 9W' 11'10" 19' 98 sq ft 124 sq ft 235 sq ft to approx 0 0 m ti io L16.5 sq ft io 0 N 280 sq ft approx total open space 9'6" 147 sq ft ;D 160 sq ft m io m ti 127" 1 15'6" 1 13' 550 Hillsdale Dr - Suite D Note: drawing not precise nor to scale