HomeMy WebLinkAboutCLE201500073 Application 2015-05-07Application for Zoning Clearance,.,
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CLE # POIS _7
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # `6 S DL Date: V1. SLa'
Receipt # 9014"7 Staff: A-3 S_?--
PARCEL INFORMATION
0-1000-01-007,303-00 Existing Zoning
Tax Map and Parcel:
Parcel Owner: C I+S O f �cy_ LLC
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fi3' City CrloSy (lt State ZiP22-
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Parcel Address:
(include suite or floor)
PRIMARY CONTACT /►
04,.1Nie Bo'lti �eR Dra • T n0 rH v J • �i MMe RI
Who should we call/write concerning this project?
8100 ��on� �a Pkw 30 City State VA Zip 23235
Address :
Office Plione: Cell toy Slq•3g56 Fax# 86 320. 1740 E-mail Connie@Cor�1aSPCom
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: PK\16' anS d ��tcP
Previous Business on this site ?
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicles, and any additional information that you can provide: "caL o �r6G•2 3eK load q eiES
*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 ac 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 �y Printed_ Ti ne r++.� J . Z ►-r t 2 ► M -P
APPRO AL INF ATION
[ ] Approve posed [ ] 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. • I
[ ] This site complies with the site plan as of this date.
Notes:
Building Official _ Date �3 t
Zoning Official Date
Other Official Date
County oT Albemarle iieparLITIMIL vi %.vuuuuwLy LcvWvF ..�...
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
Revised 7/1/2011 Page 2 of
Intake to complete the following:
Y /
Is u m LI, HIor PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
Will sere 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 ublic water?
If private well, provide Healttment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that pp e
Is parcel on septic orpa is �
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:
0/N 1
ermitted as: Me,�; <►4rLQ/
Under Section:
Supplementary regulations section:
Parking formula:
p Al -
Required spaces:
Y/
Items be verified in the field:
Inspector
Notes:
Date:
GU11lll LU L%vttl 1DLV L11G LV11VTi111 -
Violations:
Y/
If so,Pist:
Proffers:
Y/
If so, ist:
Var--ce:
Y/>,
If go, List:
SP' '
Y/N
If so, rst:
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 tine 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 owners 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
[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
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].
*Signature of A licant
Ti KOTI-N J . �.i h F-tet2 , h D
Print Applicant Name
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Date
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