HomeMy WebLinkAboutCLE201500096 Application 2015-05-26Application for Zoning, Yearance
1
CLE # b
OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS Checl< # Ito U\ Date;
Receipt # Ciq':95 0 Staff; Y�'s _
PARCEL INFORMATION
Tax Map and Parcel: 0( 1 U b-01 — 6O fO 1 fro Existing Zoning
Parcel Owner: .2- C L(-
`l.cl �� Lrace SP-oC'e„v& C� (Ag Zipzz?o/
Parcel Address: I �On -S 4-+u rN��-� T2 . City t ��An-��r�FSyr�� £ State
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? o 2 (f J uit,iv c
Address: Z�13? S CYAll Oy/Z� CityState �/h zip
17-280- /LI2rouSC�D /<F-YSTI.vE
Office Ph one:i( l2 07�Cell#�SI`f-ZN3-u3`(2Fax# '�� �`f E-mail No'��L:'t.s,
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: / i a r(..- AL -1E e" r- i- S G t -.-)-L r t tz"c6'iOrr-l�-"S
�26 r ✓v� ao2l� R L 0 C•4 T-1 or-)
*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 ha the wner's p mission to use the space indicated on this application..I also certify that the information provided
is true and accurate to the best f knowled . I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature
Printed O G ` 2 i (&D NS
APPROVAL INFORMATION Denied
Approved as proposed [ ]Approved with conditions [ ]
[ ] 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 cDate [�
1 Date ✓��/ �a��
Zoning Official
Other Official %ls Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
Revised 7/l/201 1 Page 2 of 3
Ititalce to complete the following:
Y /�1
Is use ui LI, M or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y / (fT)
Will 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 • )u -b rc ;,Wer?
If private well, provide H 4Ith rtment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that a
Is parcel on septic o ublic sewe
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:
&)'N/Permitted as:
Under Section: ASzn
Supplementary regulations section:
Parking formula:
Required spaces:
Y/
Items o be verified in the field:
Inspector : Date:
Notes:
Zoning to complete the following:
Pr ffers:
Violations:
Y/N/N
If so, List:
If so, List:
Variance:
Pis;
s/N
N 6/
If o, List: —3�so, List:
� v
l�7ryi� —
Clearances: SDP's
Revised 7/1/2011 Page 3 of 3
CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
This form must acconymny zoning applications (Home Occupation, Zoning Clearance, Zoning
Administrator Determinations or Appeals, Sign Permits, Building Permits) if the application is not the
o wn er.
I certify that notice of the application,
was provided to
[County application name and number]
[name(s) of the record owners of the parcel]
and Parcel Number
manner identified below:
the owner of record of Tax Map
by delivering a copy of the application in the
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 Al i
cIdr-)S,�— keL7i/3�/2- VP
[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 £ sa z, �£ -7-r 1,v vt 91 , 2�5
Al tq/-73-3y2(4
[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
US
Print Applicant Name
(�-/►`f/ )S--
Date
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