HomeMy WebLinkAboutCLE201500083 Application 2015-05-22Application for Zoning ClearanceG��«`'���
CLE # ;LQ
OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS
Check # CS 1 Date: SMI J
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: 0"I 100 _00100- 61-106 Existing Zoning
Parcel Owner: W 03 d LJCS rzQ e''U P • i <__,ku e_ 1 t _ S ap
Parcel Address: ,� � 0 A-t--iOa S Gfir!:�: CityQ��o_,A,4k s\_j 1-c State UA- Zip,,'?_9o3
(include suite or floor)
PRIMARY CONTACT j C
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Who should we call/write concerning this project9
Address: 9 G,4 t VV City State 1LL Zip 22ctf-4 7
Office Phone: Cell Fax # E-mail f, ncla V'al 1 0i,-94 wvy:,k_
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 shifts, available parking spaces, number of
vehicles, and any additional information that you can provide:
*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 accurate o the best of my knowledge. Ihave read the conditions of approval, and I understand them, and that I will abide by them.
a �'�"� Printed b kc_
Signature L�% l� 1 ✓1
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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 OfficialDate
Zoning Official Date 5�2�2plS
Other Official Ice- Zr, 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
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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, —7-0 VI -A
[County application name and number]
was provided to �i� tic, -tel �� Pyr �-, j the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number Q:110,3- O(3- 03- 0110 k 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 VM. , w _ 1 fv\ -m : -S
[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'``�'1 `-
Date
to the following address:
,9 0--q ! I-A'rl- &.-� , tj , v"3 . GQ -`a"-1 04� s V, I k -r , \j C, 2 -2 -go -3
[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].
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Signature of Applicant
C >Y, -c - C . c, 1, --Cc
Print Applicant Name
5-
Date