HomeMy WebLinkAboutCLE201500102 Application 2015-06-24Application for Zoning Clearance
CLE 4 9.01 S — i 0a
OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS Checl< #Date;
Receipt # � Staff;
PARCEL INFORMATION `
Tax Map and Parcel: / < CJ i1 '� n f� Bxisting Zoning (3-y�„-, do
Parcel Owner: 92 TIA In nA
Parcel Address: d (off _S City tri.L'6tltf' _ tatc Zip 2P_(8
(include suite or floor)S0, t e 5 0'D
PRIMARY CONTACT
Who should we call/write concerning this project? r lf4 S i L E 9 `PS
Address : 6 2. T'3 i' V e f3l 5_ xJ Lr AW City JState V/4 Zip
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Office Phone: ( 6 �. ell # / 2 °I x1731 ax # E-mail PCX 01,12 f h n Al inn i1 tJ 4 �
`� �5
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type:
Previous Business on this siteC7��1Q—
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: �uAPri� .y11�r�)`7�'�'1 �n t
r i l� ¢ C Q / ci) r� , 51 eC l/'
Yl
*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 th, owne 's permission to use the space indicated on this application. .I also certify that the information provided
is true and occur-thtrbest of m} owl dge. have read the conditions of approval, and I understand them, and that I will abide by them.
f
Signature Printed
._ __4� � –�—�— v
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
Zoning Official
Other Official
Date
DateII
Date
County of Albemarle Department of Community Development,
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
Revised 7/1/201 1 Page 2 of 3
c C_"'!
Intake to complete the following:
Y 1G
Is use in LI, M or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/N
ill there be food preparation?
If so, give applicant a Health Department form.
Zoning review can not begin until e receive 1p roval from Health
Dept. FAX DATE r i CL#"
Circle the one that applies Y-6 q al 15
Is parcel on private well or public water?
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 applies
Is parcel on septic or public sewer?
Y
Will be putting up a new sign of any kind? If so, obtain proper
Sign permit,
Permit #
Y /1
Wil re be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Reviewer to colmplete the followint:
i
Square footage of Use: IMP
Y rz,rmitted as:
Under Section;
Supplementary regulations section:
Parking formula: J-4 �
Required spaces:
Y 7N J �/
Item e verified in the field:
Inspector ; Date:
Notes:
Zoning to complete
Vi ati ) ns:
Y N
If so, ist:
the following:
Pro s:
Y N
If ist:
Var' e:
Y/N
If sot:
SP's•
Y/N
If so, ist:
Clearances: l-
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 (Florae Occupation, Zoning Clearance, Zoning
Administrator Determinations or Appeals, Sign Permits, Building Permits) if the application is not the
o►wter.
1 certify that notice of the application,
[County application name and number]
was provided to B E p p c-Njr=PP R l S iFS L1 C. the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel NumberI Q A 5 O c)c)Z by delivering a copy of the application in the
manner identified belo Ji
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
[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].
Signatu of Appli ant
Print Applicant Name
Date
Application for Zonln Clearance
2.0 1;
cLE #
PLEASE REVIEW ALL 3 SHEETS
OFFICE U r O Y
Check # j Date;
receipt # Staff:
PARCEL INFORMATIO V
Tax Map and Parcel: !✓ • Zoning El
Existing
Parcel Owner; Y S(1 f10 bftPLh
Parcel Address:. Q0( A e .Q V)S,. ` 3VA/ d* %y Zip22�t7�
(include suite or floor) 300
PRIMARY -CONTACT-
Who should we call/write concerning this project? :�5 � Ufl S4,0,a– --77-7s rnnd1 i G C,2
Address: Q�tg �{ City Zip ZZ -9 cyt
Office Phone: 62'N�!I(eA �2 (0 Cell # qW-N2--"37(Fax # E-rrzai3 u� Y. ►�"1� `� (', i4vwt� i t, a
APPLICANT LNFORMATION
Check any that apply: Change of ownership Cha//n��ge of use Chane of name New business
Business Name/Type l ��h� � i z A i{ i lK.��� r,� (� a 1'1-L
Previous Busfness on this site 5 g !2I
Describe the proposed business including use, number of employVes, number of shifts, available parking spaces, number of
vehicles, and any additional information that you can provide: 4 -Lk I itz _ �szS� r�uiLlav►-1 — �iL2,4
�zl
s
^ •�. �+.d vz� �. –tro t � n c� ssi,i •v`
n hO Cf ifM.!•P�r �Fi-9Z1�it71SQ •
*Ths Clearan wiles' l only be valid on the p el for which itis approved. If you change, intensify or move the usa to a new looation, a new Zoning
Clearance will be required. •
I hereby certify thato or have the owners permission to use the space indicated on this application. I also certify that the information provided
is true and accurst c e b t of my knowledge. I have read the conditions of approval, I understand them, and that I will abide by them.
__and
Signature Printed b1 1��1ZnA=V-),A I tp�
APPROVAL INFORMATION
[ ] Approved as proposed [ Approved with conditions [ ] Denied
C ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, x117.
C j No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
site plan,
C j This site complies with the site plan as of this date.
Notes:
Building Official `�. c Q,� ,� -c �,� pate
Zoning Official Date
Other Official Date'
County of Albemarle Department of Corgrnunity, Development
401 McIntire Road Charlottesville, 'VA 22902 Voice: (434) 296-5832 Fax; (434) 972-4125
Revised 7/l/2011 Page 2 of 3