HomeMy WebLinkAboutCLE201500048 Approval - County 2015-03-31Application for Zoning Clearance��,�
CLE
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY c3 Zy
Check #q -1—(—q — Date:
Receipt #0 l� 1 Staff:
PARCEL INFORMATION
larwd Dado�pmenf
OU _O g Zoning
Tax Map and Parcel: j��7� O— 00 —�% ��� I;xistin Zonin
fin'
S ^fir%( C ' < 2 r Cl�<cdYl
Parcel Owner:/
I��
Parcel Address: �g f77��// 2"OGI� City C�p �P State V zip
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project?
Address : 7 ao gWzYMel CfaJ1��eZCity �' pfd/��P/State Zip
�z
Office Phone: (�G} � ���ell # Fax # � 2 E-mail
��v
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type:
A/0G��S7`�/�
Previous Business on this site
Describe the proposed business including use, number of employees, number of ship's, available parking spaces, number of
vehicles, and any additional information that ou—ccan provide: j^ 2211 1
*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
and understand ahem, and that I will abide by them,
is true and accurate to the best of my knowI d e. I have read the conditions of approval,
(I
v u/ / Ex �
Signature Printed
APPROVAL INFORMATION
[ ]Denied
[Approved as proposed [ ] Approved with conditions
[ ] 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 Date
Other Official Date
County of Albemarle Department of Uommunu.y uCYCIVI„ucilL
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
�Iooy-
On� IeRevised 7/1/2011 Page 2 of 3
`u, �j
�fi b�
y 11�1�
W� ��►�o�I
li�Q
Intake to complete the following:
YN
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /�
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 that applies
Is parcel on private well or public 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 public sewer?
Y// N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
P,e mit # :;;- 0
Y// N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Reviewer to complete the following:
Square footage of Use: L-1ioc)
(Y / N JJ n
Permitted as: �,ycQrotu� ll�i� (�- C c1 4Under Section: !- 7 A 2
Supplementary regulations section:
Parking formula:
7 rincr e / J
Required spaces:
Y/
Items o be verified in the field:
Inspector : Date:
Notes:
Gonia to eom lute we tuiiVwiii
Viol ns:
/
If so, List:s
Proffers:Y
s N
Io,List:
o'7-- 16
Varji �ce:
Y/NN
If so, List;
�'
s
/N
f so, List:
s7
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� the owner of record of Tax Map
[name(s) of the record owner5AT 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]
M
Date
V Mailing a copy of the application to6�t/-T-01 &�
[Name of the record owner if the record wner is a person;
if the owner of record is an entity, identify the recipient of the record and t1fe recipient's title or
office for that entity]
on
Date
to the following address:
[address; written notice mailed to the owner at the last known address of the owner as snown on
the current real estate tax assessment books or current real estate tax assessment records satisfies
this requirement].
Signature of Applicant
A64
Print Applicant Name
Date