HomeMy WebLinkAboutCLE201500077 Application 2015-05-15Application for Zoning Clearance
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CLE #
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Cheek # Date: _ �r
Receipt Staff: A,5
PARCEL INFORMATION��� w �,
1`l t Existing Zoning ..
Tax Map and Parcel:
ParcelOwner: vl fL� AA, t 'TM -1
,9/
L10 A 24 L—1, 00Ul.City CW1 uu� State_P/-1 Zip��l
Parcel Address: 0 VJJ
(include suite or floor)
PRIMARY CONTACT rP 'A
Who should we call write concceerning this project?
I✓9iV4 City LVILIC State v/ -t Zip Z
Address.:�OQ U"6P1 ,,LL'
Y
Phone: UP/Cell # IV1 JULIS—L Fax #Z9 •'67 S E-mail L -NA Vr 1 rh o�.•
Office c—M
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/TypeA-16 �SVh JFl L \Jtl
Previous Business on this sit9 L,1J A3
Describe the proposed business including use, number of employees, nu ber of shifts, available parkin spa % number of
•�
vehicles, and any additio al information that you can provi L� la >y
C- 0
*This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move die use to a new location, a new Zoning
Clearance will be required.
I hereby certify that I own or have he owner's permission to use the space indicated on this application. I also certify that the information provided
is true and accura to the b o knowledge. I have read the conditions of approval, and I understand them, andthatI will abide by them.
Signature G Printed �C�� Y un AJ
APPROVAL INFORMATION
Approved as proposed [ ] Approved with conditions [ j Denied
j ] 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, itis nota determination of compliance with the existing
site plan.
[ ] This site complies with the site plan as of this date.
Notes:
Building Official 1 Date
Zoning Official Date
Other Official Date
County of Albemarle meparrmenL ui v -,um uumLy t,P-1; vl.uucil�
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
Revised 7/1/2011 Page 2 of 3
Intake to complete the following:
Y /C)
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y % N
Wi 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 private well o public water?
If private well, provide Healt Department form.
Zoning review can not begin until we receive approval from Health
Dept, FAX DATE _
Circle the onpAht applies
Is parcel o septi or public sewer?
Y /O
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y /I
Will ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
ltthfll in
Reviewer to complete the following:
Square footage of Use: is 60
0/ N.
Permitted as:�7e� ,
Under Section: Z3.2
Supplementary regulations section:
�1 Al ,
Parking formula:
Required spaces:
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
Zonin m e e to cue o ow
Viola ions:
Y/
If so, ist:
Proffers:
& N
If so, List: 41,
VOVari. ce:
Y/V
If so, List:
SP's•
If so, List:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of
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 the application is not the
owner.
I certify that notice of the application' �(J U
[Count application name and number]
was provided to Ivl �G1 Cl P1 the owner of record of Tax Map
[name(s) of M6record owners of the parcel]
and Parcel Number `l�`� 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 .
v 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 ZIf 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].
J�
SigVaature of Applicant "
Print Applicant Name
Date