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HomeMy WebLinkAboutCLE201500070 Application 2015-04-2306- 'rf'-2- V1A CT R, , , -) A I < 09 1 Application for ZoninF Clearance �t_ �_"� � CLE # 02O 5 -__7 '���fH[IINIP '' ` PLEASE REVIEW ALL 3 SHEETS OFFICE USE ONLY Check #Date,. CR OQ Staff; Receipt # PARCEL INFORMATION Tax Map and Parcel: * � "'2- W ..,� - 60 4j 04 �Cit� Existing Zoning 1"t -A� � � � Parcel Owner: oL,,► �tF1 Parcel Address: City vif� d ��St?ate ici Zip i? (include suite or floor) PRIMARY CONTACT Who should we call/write concerning this project? Address :_f .9-[S C6 L_ f sow% fel LA_ Q city i i 1c. State U A" Zip a' � Office Phone; (h3 l) 99,5_14t` ell # q62 2 ° 91elw(p Fax # 1'J tk E-mail S Rt""J APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business Business Name/Type: S � G '�' Previous Business on this site Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of S f-�l�I vehicles, and any additional information that you can provide: 1i��� i arc (Z=�►�a'4 r R --r 1 G —12 C­,eK-p i2� *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 a er's penrussion to use the space indicated on this application. I also certify that the information provided to o kno 'ledge. ave read the conditions of approval, and I understand and that I will abide by them. is true and accurate est y /them, Printed C�--, 3r% Signature APPROVAL INFORMATION [ ]Denied `Approved as proposed j ] 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 �{��/-T-� Zoning Official Date Other Official Date C.onnr:y Ol %1Oem2JFJC uGNaruaici,L r...---_ 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5532 Fax: (434) 9724126 Revised 7/1/20I1 Page 2 of 4CUEmoo C�ohq , E;'l (�__ Intake to complete the following: Is /MD Is usYin LI, Hl or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet, Y/ Will t ere 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 privatewell oridater? If private well, provide Heal apartment 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 lic se ? Y/N Will you be putting up anew sign of any kind? If so, obtain proper Sign permit. Permit # Y/N Will there be any new construction or renovations? If so, obtain the proper Pelmit. Permit # _ ;2 % Reviewer to complete the following: Square footage of Use: 0/ N Permitted as:� ► Under Section:. 2•� Supplementary regulations section: Parking formula: . Required spaces: l� Y 1�5 / Items to be verified in the field: Inspector • Date: Notes: Zoning to complete the following: Violat ons: Y/I If so, List: Proffers: /N 1 so, List: 2 Variance: Y/� If so, List: S /N If so, List: 6�S 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 Appends, Sign Permits, Building Permits) if the application is not the owner. 1 certify that notice of the application, _ �Z-` ��`'� (Z, [County application name and number] was provided to cbt-L.,-O 2 &�IV GpjA Z --the owner of record of Tax Map [name(s) of the record owners of the parcel] and Parcel Number e)u3,200-00-0a` 3o O by delivering a copy of the application in the manner identified below: Hand delivering a copy of the application to 40 [Name of the record o4ner 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 CJC)l��L C:�—ior��IL�S (ten` (Z�^ZC J°') [Name of the record owrkr 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'::V 1 office for that entity] on _ LJ �) IS to the following address: Date i©D [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]. Signature of Applicant Print Applicant Name /1* -a b tui► s' - Date n- .257 B Conner Drive 3,083 SF.4.,,-- I4 PLAN ROQ-1 =IN15H 6C=EOULE A, P.ARTITIO\ SCHEDULE Copy of Kidands plans.pdf (1) (112% of Scale); Kirkland Space TC Hollymead; Dennis New; 3/18/2015 04:31 PM O -- --------- -- . . ........ ... .... ......... .... . �1501N�8- GODE INFORMATION Q -- --------- -- . . ........ ... .... ......... .... . �1501N�8- GODE INFORMATION