HomeMy WebLinkAboutCLE201200082 Legacy Document 2012-05-01Application for Zonin Clearance
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CLE # ZM /Z - R
-1 t �R�i 0
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY G/, / ,/�
Check # 0 Date:
Receipt # 3 Staff:
PARCEL INFORMATION✓✓� _ D D_ D D 2/ Q /T
Tax Map and Parcel: /% 1 ,7 (� Existing Zoning
Parcel Owner: RQ,G of S n��S <3 C_
Parcel Address: r64 ,ag. TC&LI—City fw,-L&Ld& 6U Z& State % Zip z?-gt7
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? ? Ui Cr
ff4e_tJ--
Address: u ��� �� -7 City CV-a c-(4A,S_sd6,, State Zip/��Z -°Go
Office Phone: &3) 29l -y ,—o) Cell #X93 —bOO Fax# 2-13 XA E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use _Change of name, New business
sh
O X f
Business Name /Type: /
Previous Business on this site
Describe the proposed business including use, number of employees, number of shh, s, availablg�parki g spaces number of
Z- /41775, IZ�TS
vehicles, and any addit' nal inf mation that you can provide: // / j Q
/� 10 r 'P
*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 /,V
APPROVAL INFORMATION
Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] BacHow prevention device and /or cun•ent 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 DateT��
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
E,GGL
4K_
Intake to complete the following:
Y / (.
Is use to LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
V/ N
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 at a p
Is parcel on rivate or public water?
If private well, prove ealth Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel i or public sewer?
Y / No
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y /Q
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to comDlete the following:
Reviewer to complete the following:
Square footage of Use:
&?/N
Permitted as: qrit,4 cc,
Under Section: �j /col 3 %
r
Supplementary regulations section:
Parking formula:
Required spaces:
Y/
Items o be verified in the field:
Inspector : Date:
Notes:
Viola ons:
Y / Al
If so, List:
Prof s:
Y /
If so, ist:
Var' ce:
Y1(
If so, List:
SP's:
6/N
If so, List:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3
CERTIFICATION THAT NOTICE OF T
APPLICATION HAS BEEN PROVIDED TO THE ANDO`VNER
This form nzus accompany zoning applications (Home Occupation, Zoning learance, Zoning
Administrator D erminations or Appeals, Sign Permits, Building Permits if the application is not the
owner.
I certify that no ice of the application,
[County ap ication name and number]
[name(s) was provided to the owner of record of Tax Map
[name(s) of ne record owners of the parce
and Parcel Number by delivering a copy of the application in the
manner identified below:
Hand delivering a copy of \isa ation t
[Name of the record owner if the record owner is a
person; if the owner of recnti , identif y the recipient of the record and the recipient's
title or office for that entity
on
Date
Mailing a copy of the applic ion to \
[Name of
if the owner of record is a entity, identify the r
office for that entity]
on
Date
record owner if the record owner is a person;
Zient of the record and the recipient's title or
to the following
[address; written otice mailed to the owner at the last known ad ess of the owner as shown on
the current real tate tax assessment books or current real estate t sseesment records satisfies
this reauiremen 1.
Signature of Applicant
Print.Applicant Name
Date
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