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Home My WebLink AboutCLE201500075 Application 2015-05-12rxJULi a kiw01bi✓ Application for Zoning Clearance m CLE #O IS- — —7 S� "1" PLEASE REVIEW ALL 3 SHEETS OFFICE U Check # Date: 4 - i,�) Receipt # Staff.• PARCEL INFORMATION �% I f j'�}� u L Is_ Tax Map and Parcel: o— ! Existing Zoning' r �7 I Parcel Owner EW ! l U=T, cap_ ,_ I Parcel Address: ' `� �fit %1� K-� icity State Zia .. (include suite or floor) PRIMARY CONTACT�� 1.�y Who should we call/write concerning this project? C.l.��l/Ll�) '' Address/l(J dC��- City State ZipL%�� Office Phone•q!MAR _;z_ Cell # X Fax # E-mail APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business Business Name/Type: Previous Business on this site Describe the proposed business including use, number of employees, number of shift , av able parking spaces, number of � 5�s- vehicles, and any additional infor atio that you can rovide: � *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 d a to t&lhbest of my knowledg . I ve read the conditions of approval, and I understand them, and thAatt I wi abi ebythem. Si at Printed APPROVAL INFORMATION ] Approved as proposed [ ] 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. [ ] This site complies with the site plan as of this date. Notes: Building Official AX DateP-4 `�- Zoning Official Date _5-1-7 / zl(S Other Official Date County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126 Revised 7/1/2011 Page 2 of 3 7 7 CERTIFICATION THAT NOTICE OF THE APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER This fonn 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, , 1 , / ^� CaA,- [County application name and number] was provided to_YE�& I HU-/yf the owner of record of Tax Map [name(s) of the record owners of the parcel] and Parcel Number 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 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 to the following address: Date [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 Date Intake to complete the following: Y Is us LI, HI or PDIP zoning? Engineer's Report (CER) packet. If so, give applicant a Certified Y Will Qthebe 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 on at ap lies Is parcel o rivate well r public water? If private wel , provide Health Department form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the on at applies Is parcel o4 septic or public 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 # Zoning to complete the following: Reviewer to complete the following: Square footage of Use: %/N Permitted as: /Vv N C // Under Section: b� Supplementary regulations section: Parking formula: Required spaces: Y / .. Ite to be verified in the field: Inspector Notes: Date: Violations: Y/ If so—,List: Proff rs: Y/ If so, ist: Vari nce: Y/PSI If so, List: SP's: Yi If so, ist: Clearances: SDP's Revised 7/1/2011 Page 3 of 3 -. .. .0 r1. _ r, -- Y, KES1.WICKHOR0.SE S O GR I , .. - x ,zm6 t' �� t{ �', r l r ' J�Xi 1. , ; ^-u. 113'7 1 } 41. Y k! s* it ri� } t t �.gg aaJ `''rSF , g,- �YStcYYt ff.-;,2,1.T.. (, . 1 y1{ r v �E jt),i / iSli l .({ t l 'hl r -1 yiff. . S�, ,jl � ?•!i x l,��t u 1 r t ? r r. L� t ��c G 17� S 1 S �k { 1{ f 4r is ��t�)F �t�rri}�! 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