HomeMy WebLinkAboutCLE201500047 Action Letter 2015-04-02Application f®r Zoning Clearance
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CLP # 2„C) is —
CLE
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY 3
Check # 2-1-7 Z Date:
Receipt # 1 �— Staff:
PARCEL INFORMATION 1 0WA rn
Existing tonin _
Tax Map and Parcel:
A-J�rp;��t 5o i
Parcel Owner•:
Parcel
Srl^r�
Parcel Address: 3�� [9�f po'r`t— City CGzS�fi �Q State Zip ell
—( cludesuiteorfloor)
PRIMARY CONTACT-8,'(kJAVA&)
Who should we call/write concerning this project. ('�
l � � �dX .0 tk City Cul State VA Zip ZZ Y
Address : �---
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Office Phone: ell # Ly Fax # E-mail tnf chi✓nyAr► &_I k &
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type; cufatuo 1 Z;�A4-PrIj
Previous Business on this site 0�-W'L��`�� �Tl
Describe the proposed business including use, number of employees,, of shifts, availableprldng spaces, number of
vehicles, and any add�'ti°`n I information that you can provide: i n�.'� r- 'hf� _ t� Q. � '
*This Clearance will only be valid oilthe 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
knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
is true and accurate to best o my
Signature Printed
APPROVAL INFORMATION
>4 Approved as proposed [ J 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.
[ J This site complies with the site plan as of this date.
Notes:
Building Official ._ iii Date �t �
Zoning Official Date
Other Official Date
County 01 A!oemarie iLepartulrill,- %-VL1All uAIALT — —IJ ... --
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
Revised 7/1/2011 Page 2 of
Intalce to complete the following:
Is u�n LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/6
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 orie w r?
If private well, provide Healthublapartment 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 pi Iic sewer
Y/N
Will you be putting up a new sign of any kind?
Sign permit.
Permit #
If so, obtain proper
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: % o v
l N. , II
ermitted as; C� Jf1 rvin�iAs r�
Under Section, �2 ` I
Supplementary regulations section;
Parking formula: /
�,M�;,IOYe c�• "f I��v �
Required spaces:
Y/V t�
Items to be verified in the field:
Inspector : Date:
Notes;
to . ningy to complete the followin ;
ti�solations:
'/N
If so, List: 1 n
Proff s;
Y/I
If so, List:
Variance:
Y/
If so, List:
�s'
Y/N
If so, List: `
Clearances:
SDP's
Revised 7/7/20]] Page 3 of
CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER.
Tltis form must accompany zoning applications (Home occupation, Zoning Clearance, Zoning
Administrator Determinations or Appeals, Sign Permits, Building Permits) if tyle application is not the
owner,
j' Giz
I certify that notice of the application, ��' I 1 a � Pa;.A�s ci` 6 (a
HAwseq A(J1,�, I- Plate [County application name and number]
was provided to I eAL— 1 ' ,nGW I h M� O'"+ the owner of record of Tax Map
[name(s) of the recor
d o-hners of the parcel]
and Parcel Number 3 D 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 .
/Mailing a copy of the application to %` �`
[Name of the record o ndr if 6e reco d 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 3 / ��� l5� to the following address:
Date II &�
1
[address; written notice mailed to the owner at the last known address of the owner a shown on 044v
the current real estate tax assessment books or current real estate tax assessment records satisfies
this requirement],
Signatur4 of Applicant
vv I
Print Applicant Name
Date
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