HomeMy WebLinkAboutCLE201500115 Application 2015-06-08Application for Zoning Clearance
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OFFICE USE UNLY
PLEASE REVIEW ALL 3 SHEETS check # Date:
Receipt # Staff;
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PARCEL INFORMATION
Tax Map and Parcel: NO 1 !.3003000 18ip Existing Zoning
Parcel Owner: 15� I')Ous VAIL Pxc-p(zn e LA-(!.
Address: i*jo4,mo&,-rpI ST zto&ity t7i�ialRLiSlCL7�UlC Ee VA Zip fll
Parcel
(include suite or floor)
PRIMARY CONTACTQ ����
Who should we capll,/wwr'ite concerning this project?
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Address : -�'�` Z( City CgAA��V1U#ate V A ZipT�iob
Office Phone: ( ZC7Z' (D Cell # `T►a(o86/�'ax # E-mail VOLtea M.Ou1
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APPLICANT INFORMATION
Check any that apply; Change of ownership Change of use Change ofa name VNew business
Business Name/Type;
Previous Business on this site
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, numper of
vehicles, and any additional information that you can provide: O
*This learance 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 oi or h e the owner's permission to use the space indicated on this application. I also certify that the information provided
is true and accurate to tl best in owledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Printed�AI.�IQ
Signature
APPROVAL INF RMATION
'] Approved as proposed [ ] Approved with conditions [ ]Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, x117.
inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
[ ] No physical site
site plan. • I
[ ] This site complies with the site plan as of this date.
Notes:
Building Official Date GjIcK
Date
Zoning Official
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
23
Intake to complete the following:
Y/N
�s use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/4
Will there 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 p lic ter?
If private well, provide Healt 1 t ent form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that app -1 les,
Is parcel on septic or pti is sewer'
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; 2 0 a
&/N
Permitted as: 6'" 1 ccs�✓l� -6le-S'`l 4"
Under Section: �Z',/ ' 2— /
Supplementary regulations section:
Parking formula: 2 Ob
Required spaces;
Y/
Items o be verified in the field:
Inspector:
Notes:
Date:
c�On111g Io culn IUM LIM 1V11Vrr111
Viola ions:
Y/q
If so, lst:
Proffe�s:
Y/�
Ifs , 1st:
Variance:
()/N
If go, List:
SP's:
0/N
If so, List:
Clearances:
SDP's
Revised 7/l/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,
[County appli tion nai number]
was provided to �'+'i. the owner of record of Tax Map
[name(s) of th rd owners of the parcel]
and Parcel Numbers fjJ���fig® by delivering a copy of the application in the
manner identified below;
Hand delivering a copy of the application to
[Name of the record wndr 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
[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
[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].
Signa re of A pp scant
Print Applicant Name
jq-1
1!5
Date