HomeMy WebLinkAboutCLE201500121 Application 2015-06-19Application for Zoning Clearance
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OFFICE 1QSI' ONLY
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PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Receipt # i oo a G, Staff: f3S
PARCEL INFORMATION
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Tax Map and Parcel: O` 900 -O•Q O •O 5 1 t-0 Existing Zoning `/ Ae
Parcel Owner: VS p &U i lA� h q N tc L UL
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Parcel Address: Sta t' 135 CityC-ty--to4Jt3vi State V Zip
(include suite or floor)
PRIMARY CONTACT
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Who should we call/write concerning this project? Ir ,
Address : to ll :5LVlniny 4, & AKC.� C4-. City ` -eco ct tiCState Y d Zip ZU114
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Office Phone: Kn 91- Y$1ZCell # Fax # E-mail sc.o z t y t�CC VA .Co
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type:?hTMOT 1000%%%1t1zQ-LtA L 66� MEQ-TG2S� l {.1 4L
Previous Business on this site ? (� FRGC7
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, numb�j� of
vehicles, and any additional information that you can provide: 2• - M 0L" I G'Z S - 2 - Ve. fit, i G�l[
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*This Clearance will only be valid on the parcel for which it is approved. If you change, intensiy 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 bes oflity nowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
SL 0 -r T 1?A v—y—e Qf
Signature Printed
APP,ROVAL INFORMATION
[ pproved as proposed [ ] Approved with conditions [ ] Denied
[ ] B flow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, x117.
[ o 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 (o I- i-�C
Zoning Official 4tLce Date liq I
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/0
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
Y/(9
If so, give applicant a Certified
Will there be food preparation?.
If so, give applicant a Health DBpartment'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 blic wate
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 appli .
Is parcel on septic public sewer?
Reviewer to complete the following:
ware footage of Use: I b O
Permitted as: t }RQ U t,,
Under Section: )M A— - 9 1 t
Supplementary regulations section:
Parking formula:
Required spaces;
IIN
Ite e verified in the field:
Y/�
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit # Inspector
Y / .. -Notes:-
Wilqtere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Date:
Violations:
Y/N
If so, List:
Arrffers:
�V N
Eso, List: \ i
Varir4 ce:
Y/ 1,
If so, ist:
SP'
Y /Vj
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,
[County application name and number]
was provided to? V FS �Z W;.., 6 +fit L L (— the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number 019 0 � . e I • 0 0 . 6& <-y by delivering a copy of the application in the
manner identified below:
Hand delivering a copy of the application to
[Naive 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
[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 ( o' q ' ( � 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].
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Signature of Applicant D 1
S..A rte of�'ke,- rl.
Print Apli ant Name
Date
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EXHIBIT -A
LOCATION PLAN OF PREMISES (NOT TO SCALE)
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