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HomeMy WebLinkAboutCLE201500087 Application 2015-05-15Application for Zoning Clearance n`t� CLE # OQ A S — $D � �w s„ �77;GIN�a OFFICE USE ONLY PLEASE REVIEW ALL 3 SHEETS Check # Sa 6 Date: i - Receipt # 10LI Staff: AACL PARCEL INFORMATION Tax Map and Parcel: cy01 -00'-/ y — Q 0 14) O Existing Zoning Parcel Owner: o cl r v C P Parcel Address 6_ City STa e I/ Zip (include suite or floor) PRIMARY CONTACT D✓'1� C Gd h Who should we call/write concerning this project? �Q h� �_/ "l1 t (�Q'� Address: [/ City State !/ Zip Office Phone: 0 Cell # f i '& Fax # 11 E-mail of r cd ca"vl APPLICANT INFOR ION Check any that apply: Change of ownership Change of use Change of name New business Business Name/TypeGe APiUr_\1 Previous Business this r _ on sited Describe the proposed business including use, number of employ s, number of s ifts available parking spaces, number of information that vehicles and any additional you c n provide:"- �t� „t. GiY o. *Tliis Clearance will only be valid on the par el or 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 certi I own or e rmission to use the space indicated on this application. I also certify that the information provided is true an accurate o t y e Me. I h ve rad the conditions of approval, and I understand them, and that I will abide by them. Signatur Printed 116 AP ROVAL ION Approved as proposed [ ] Approved with conditions [ ] Denied [ ] Backflow prevention device and/or current test data needed for this site,. Contact ACSA, 977-4511, xl 17. [ ] 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 1 (C (� Zoning Official Date J�L3�Za%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 cgre, Cv &M Intake to complete the following: Y / CN Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y /rN Wil 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 pu is wa r? If private well, provide Health Department form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that appl` e - Is parcel on septic or ' sew •? 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 # Zoning to complete the following: Reviewer to complete the following: Square footage of Use: I-� D 3 Permitted / N q/ IT Permitted as: Under Section: Supplementary regulations section: Parking formula: / Required spaces: �\ Y/N (� Items to be verified in the field: Inspector : Date: Notes: Violations: Y/ If so, ist: Proffe s: Y/i If so, List: Variance: Y/jN) If so`, List: SP's: Y/R) If so, List: Clearances: SDP's Revised 7/1/2011 Page 3 of 3 n 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, . O-61 )P i�O ✓L J vA C ),ecema I't CP Lti[County application na e and number] was provided to �G ��c (9 �c �(c©t H . Wtcc Vl Q the owner of record of Tax Map [name(s)of the record owners of the ar el] and Parcel NumberCVM---Q -00 !-'Oo � bo by delivering a copy of the application in the manner identified below: 1� O � L, —c Hand delivering a copy of the application to I t �t 1 t& r K 1 !� c)- ►-t �`- 2 Gr [Name of the record owner if the record owner is 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] 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]. b 05 Print Applicant Name IF Date