HomeMy WebLinkAboutCLE201500104 Application 2015-06-01Application for Zoning Clearance
CLE # .a��'-- [ 0
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OFFICEUSE ONLY
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PLEASE REVIEW ALL 3 SHEETS
Checic # Date:
Receipt # IT166 Staff: A—S (Z—
PARCEL INFORMATION
Tax Map and Parcel: 061 WO-01-OA-009AO Existing Zoning C-1
Parcel Owner: Sue A. Albrecht
Parcel Address: 2300 Commonwealth Drive City Charlottesville State VA Zip 22901
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? Sue A. Albrecht
Address :255 Ipswich Place City Charlottesville State VA Zip 22901
Office Phone: (�34) 531-2436 Cell # 434-531-2436 Fax 4 434-973-0732 E-mail sue@designenvirons.com
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of naive X New business
Business Name/Type: Hair 2 Please
Previous Business on this site Blue Ridge Internet
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:
Hair Stvlists. 3 Emolovees. 1 Shift - 48 Available Parkina Spaces & No Comoanv Vehicles
*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 to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed
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 Official J� . Date
Zoning Official Date
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
Intake to complete the following:
Y (�NllIsuLI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y cereWbe 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 public waFent
If private well, provide H form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that appl'
Is parcel on septic o public sewer
N
ill you be putting up a new sign of any kind?
Sign permit. 7�
Permit #
If so, obtain proper
Y/N
ill there be any new construction or renovations?
If so, obtain the proper Permit.
Permit # if C—
Zoning to comDlete the following:
Reviewer to complete the following:
Square footage of Use:
,;Y/ / N / r
Permitted as:
Under Section: 2-:2, ?'-)
Supplementary regulations section:
Parking formulae
"4 4' COY'6-3
Required spaces:
Y/
Items to be verified in the field:
Inspector:
Notes:
Date:
Viol at ons:
Y/D
If so, List:
Proffers:
Y/
If sPlist:
Variance:
O/N
If so, List:
SP's:
Y/V0
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
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, Suc ;o 41's fcct uti—
[County application name and number]
was provided to Ug- A 4l9 2.%[Q. N r- the owner of record of Tax Map
[narne(s) of the record owners of the parcel]
and Parcel Number 0 (o ) VJO —O l -1? 4ay delivering a copy of the application in the
manner identified below:
Hand delivering a copy of the application to l 0MA2 0W..J 6 U1_,,K !2V5hJ -CX' C4nX /L'
[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 AMuA1mw4 ✓01C4dLr-,'
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].
Signature of Axicant
,.0 uL g&
Print Applicant Name
Date
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