HomeMy WebLinkAboutCLE201500080 Application 2015-05-12A lication for ZoningClearance
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pp CLE # \S — ��
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY ' S
Checic # (0.612 Date:
Receipt# o,016`70 Staff:
PARCEL INFO`R•'Aro)"N
�Tax
�--� — V �� Existing Zoning
Map and Pare
Parcel Owner: o ,\C UJL
Parcel Address: '�15_lO 2'ew50V'� CA_ City (V\a4,c A-e3\J`'I`�'—State Zip
(include suite or floor)
PRIMARY CONTACT
Who should wwe/call/writ concerning this project? Ao_WNW
tb � -'Y � ( ity 1 Zip �� 6
Address:(/
Cell # 3 '�✓ —Ir" X #�� E-mail (01Q,14
Office Phone: (_�
APPLICANT INFORMATION
Check any that apply: Change of ownership Change ofuse Change of name New business
Business Name/Type:
Previous Business on this site-�
Describe the proposed business including use, number of emplo ees, number of shifts, a ila e parking solaces, number of
��.•
ve, icles, and any additional informs ion th you can provide: (-
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V
/
*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 t own or have the owner's permiss'on to use the space indicated on this application. I also certify that the information provided
is true and accur e o the best of y wledge. I h ve read the conditions of approval, and I�understand them and that I�will abid by them/.�
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Signature r Printed
re 1
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.
inspection has been done for this clearance. Therefore, it is not a determination of compliance with the'existing
[ ] No physical site
site plan.
[. ] This site complies with the site plan as of this date.
Notes:
Building Official �— Date (J
Zoning Official / Date�y�
Other Official Date
County of Albemarle Department oI t,om[nwuly "t;VVAvin//o AL
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
Revised 7/1/2011 Page 2 of 3
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Intake to complete the following:
Y/N
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/N
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 puttl wa r? .
If private well, provide H De artfnent form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one th =public
Is parcel on septi
Y/N
Will you be putting up a new 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 Permit.
Permit #
Reviewer to complete the following:
Square footage of Use: y ��
61N 1J �
Permitted as: /`M QJi1�tr_jL'�"rit"�
Under Section: 2 4--_
Supplementary
--_
Supplementary regulations section:
Parking formula:
Proffers:
Y /yIf
If so, st:
Required spaces:
Yk-
Itee verified in the field:
Inspector :
Notes:
Date:
Vari. ce:
Y / I"
If so, list:
SP's• ,)
Y
If so, List:
Zoning to complete the..following:
Violations:
sd; ?ist:
Proffers:
Y /yIf
If so, st:
Vari. ce:
Y / I"
If so, list:
SP's• ,)
Y
If so, List:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3
CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
Titis 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, -Zo
[C�� 01-4
ounty a p ication name and number]
was provided to CIL' the owner of record of Tax Map
[name(s) of the r ord owners the parcel]
and Parce umber
by delivering a copy of the application in the
mamler 'dentified below;
6
Hand delivering a co of the application to
PY
[Name of the record wner if the re rd 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
�5) I I I ...-
-5
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]. .
r
Signa re of Applicant
Print Applicant Name
Date t(