HomeMy WebLinkAboutCLE201200032 Legacy Document 2012-05-23i
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Application for Zoning Clearance`'
iY tL
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE Y
Check # � Date: 'la " iZ
Receipt # Staff:
PARCEL INFORMATION ii Rapr �i badb
L9 I • �� Existing Zoning t(�L >'il�1i
Tax Map and Parcel: I
Parcel Owner:
Parcel Address:,�/VZ City d/� /4--State I J4,- Zip
(include suite or fl or)
PRIMARY CONTACT /+
4,Z,4
Who should we call /write concerning this project? i�iC?T
V
Address : .3pOJ M14gA -k. b',+ aC+ City e1tAC1&14&1Ak-State VIA4— Zip ZZ9 a
Office Phone: �" g�S '� Cell # 4 � � 419( Fax # E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership of use Change of name New business
', ', rrChange
Business Name /Type: % /�i= Ted 62Ea� / ags-he :5
2
Previous Business on this site
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
/°/�✓ �C�Ci��uuL �� /rS
vehicles, and any additional information that you can provide:��C
,
*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 perjnussion to use the space indicated on this application. I also certify that the information provided
I by them.
is true and accurate tot est of.. no dg I have read the conditions of approval, and them, and that will abide
,IIuunderstand
Signature C Printed 4-2 2T
APPROVAL FORMATION
Approved roposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, xl 17.
[ ] 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 �,�5 Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: .(434) 972 -4126
Revised 1/1/2011 Page 2 of 3
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Intake to complete the following:
Y (2
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/N
ill there be food preparation?
If so, give applicant a Health Department form. (`
Zoning review can not begin until we ecei e a roval fi-om Health
Dept. FAX DATE I�a
Circle the one that applies
Is parcel on private well or ublic water?
If private well, provide Hea nt form.
Zoning review can not begin until we receive approval fi-om Health
Dept. FAX DATE
Circle the one that appfi
Is parcel on septic r public sewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign pen-nit.
Permit #
N
Will Will there be any new construction or renovations?
If so, obtain th ro er Permit. i �,`' �
Permit# t 0• — l(�l(. ,(f wylow ',� )
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: 91-0
O/N
Permitted as: p aml, L
Under Section: �Z. • l
Supplementary regulations section:
Parking formula-
//5 oD
Required spaces:
Items to be verified in the field:
Inspector:
Notes:
Date:
Violations:
6/N
If so, List:
Prof s:
Y/N
If so, List:
Variance:
Y/N
If so, List:
SP's:
(1 /N
If so, List:
Clearances:
SDP's
Revised 1/1/2011 Page 3 of 3
ZONING FLOOR PLAN ICE G i�E ,4 I UV A �E i"� 0 U ef-=
PROJECT � . AS622 DRAU.N BY: JLS, AMV .
DATE: FEBRUARY 10, 2012 CHECKED BY: JLS, AMV 622 ALBEMARLE SQUARE, CHARLOTTESVILLE, VA 22eOl
SCALE: 3AW . 102012 - CT2 TECTONICS LLC
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ZONING FLOOR PLAN ICE G i�E ,4 I UV A �E i"� 0 U ef-=
PROJECT � . AS622 DRAU.N BY: JLS, AMV .
DATE: FEBRUARY 10, 2012 CHECKED BY: JLS, AMV 622 ALBEMARLE SQUARE, CHARLOTTESVILLE, VA 22eOl
SCALE: 3AW . 102012 - CT2 TECTONICS LLC
CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
This form must accanpany 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 �� f �t ��"�� �L he owner of record of Tax Map
[name(s) of the record owner of the parcel]
and Parcel Number
manner identified below;
by delivering a copy of the application in the
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 � 1"s
[Name of the record owner if the r ord 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]
Oil
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].
Date