HomeMy WebLinkAboutCLE201200088 Legacy Document 2012-04-30N, A mz)a L
Application for Zoning Clearance
CLE# AL12 '66
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OFFICE USE NLY
USE I
PLEASE REVIEW ALL 3 SHEETS
Check# Date:
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: e26'1 k10O C2t —CZ) Existing Zoning
Parcel Owner: 1gZi9 -1#e4 .4d,l,
Parcel Address: �y C" %1/�!L -%Z / /ll7i` " City /ice / -,- --s t ate 1114 Zip
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project?
111 F 1-17r ='% Q('Ifl/ City /�� ���� State Zip f�`I
Address : / / /�c.S•
�o kT JA2 i/U � la
Office Phone: Cell # 97 :f� L Fax # 3d /�y I E-mail E -mail C /�/ . ��
APPLICANT INFO ION
Check any that apply: Change of ownership Change of use Change of name New business,
Business Name /Type: �r��/ �%�7l/l�C����! �/G ✓��
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: a Z/,Rwyons
i�i�tirr� /t✓ �1�. 3 --- ci l���f /(%GG '" /?('U�15 9 r�//tir T� 7/12 /6�,7
*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, anew 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 o the best of m wledge. I h - e read the conditions of approval, and I understand them, and that I will abide by them.
Signature �' / Printed �J ����� / f�/���7
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
Zoning Official 4 Date
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22962 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 7/1/2011 Page 2 of 3
Intake to complete the following:
Y
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
Will bre 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 apple
Is parcel on septic or ublic sewer
Y/V
Will you be putting up a new sign of any kind?
Sign permit.
Permit #
If so, obtain proper
Y /6
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: S D y
Permitted as:
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces:
Y/
Items to be verified in the field:
t1 4 e, p- j)L JA✓1-,4, %'g a AJ V
Inspector : Date:
Notes:
Violations:
/ N.
If so, List: j
Pr s:
Y so,—List: (N
If
Varl ce:
Y/
If so, ist:
P's:
/N
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 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 l�f� — /��6 C�it/�i� /�� /'�/�2i G�!C�the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number 626%GI/U-0/-6t�,' — 6V A0`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
l /Mailing a copy of the application to 4ffl?Y -I X/V
[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 �Ir'�z /L to the following address:
Date
[address; written notice mailed to the owner at the Idst 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].
VF
Siinatu e of pplicant
Print Applicant Name
Date
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PIN IPOr perty Address 'Owner
061WO- 01 -00- 0020011486 GREENBRIER PL 11420 -1486 GREE
1 selected To Mailing Labels To Spreadsheet 1
Parcel into 11 vwner 1
Print
Parcel ID 061WO -01 -00 -00200
Full Property Information here
Owner Information
Owner 1420 -1486 GREENBRIER PLACE
#1 LLC
Address 1935 TAYLORS GAP RD
NORTH GARDEN VA, 22959
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