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Home My WebLink AboutCLE201500129 Application 2015-07-02-dP Application for Zoning Clearance' CLE # o — k 2M �t. A: �- PLEASE REVIEW ALL 3 SHEETS OFFICE USE ONLY Cheel[ # CerSy Date: Receipt # j()Q a61 Staff: PARCEL INFORMATIONj o `� —0j�/�/� Tax Map and Parcel: 1 x' �`-y Existing Zoning J iA Parcel Owner: C/2o� � i Sfha Ce-Xt—EYt-S ' /Z6)1VW t-1?4y io wwQAt'r- 04.'S.31 es% � Parcel Address: 54W. A 'Rr-,e No7CW &J City C443-t,.s- State VA Zip Z'L (include suite or floor) PRIMARY CONTACT uu /7OrUAs Who should we call/write concerning this project? h/S9AM Address: *Z::krq �o i��, si�1 A.- City h/tki goo6,0 ,Y State MC Zip Z��3 Office Phone: Cell # f/n BS7 7 Fax # E-mail —PUSSGn, `f' (� JA,& �.fa 3n i/ APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business Business Name/Type: �?A#vy rS Ho 7 210(r f nrD 0/e- C 4 c)1&T Previous Business on this site 4AI( S 667- (2007 SM -40 0i= CYt 0.7 01— 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: 5AwrE' AS S4r aYff — Ctto-10` i T?ewN?Uh/ cs-r C/ ' *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 ledge. e ead the conditions of approval, and I understand them, and that I will abide by them. Signature ��2!plw 16 S Printed '_176444f/r►"� AP O AL INFORMATIO [ Approved as proposed [ ] Approved with conditions [ ] Denied [ ] 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 sit ompIies ith the ite plan as ofthis d Notes: I Building Official Date( �1n� Zoning Official VAAAXL� Date 1 le?lo 1 % Other Official Date County of Albemarle Impartment of e:ommumry.0eve►opment 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 Is use in LI, HI 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 w receive approval from� Health Dept. FAX DATE t Circle the one that applies I 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/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 # / '7-.,.-- +n thn fnllnwina- Reviewer to complete the following: Square footage of Use: L / N �u ermitted as: Under Section: ad , q. k (sq Supplementary regulations section: Parking formula: UV11111 LV —lla Violations: Y/ -N If so, List: Proff Y/ If s ist: Variance: Y/N If so, List: SP's• Y/N If ist: Clearances: SDP's Revised 7/1/2011 Page 3 of 3 (PNG Image, 863 x 868 pixels) https://mail-attachment.googleusercontent.com/attachmentl?ui 2&ik=... S'-7�s6 A -T(11,,&e /Uo-- ,W (2G(., Crowt , clA -zag3Z . 056 AL -o(-pn-OZ7ob ^-'tOt S1, �. C � r S.�W"Ld 1 of 1 6/29/2012 1:44 PM � Application for Zone Clearaikg' cLI♦ #f PLEASE REViE'V4''ALL 3 SM�WTS OFFICE USE ONLY Check# 11 U Date: Rtceipt # u?) staff; YYI�iCC'� PARCEL INFORMATION _/ Tax Map and Parcol; oqy, 'T ��."� 2-17� Existing Zoning Parcel Owner; but ---To, i Parcol Address: Jrli�(v[�IrCY r' City, Stated zip (include suite or hoar) PRIMARY CONTACT '-�('�j 11 ��} 1010 who should Nye call/wriconcerning this project?, n )A //te Address OZ 64 City State V+�r' Ztp dz5'3� ;�4. -e Office Phonel CeII #�69/3 Fax # Fr mall SYt ti � ro Csnrc' �. t APPLICANT INFORMATION Check any that apply: Change of ownershipof use of'name New business 1Change �J)) JChange do 'kiC'. a�� f�t��f✓D 0. ��/� ��Sf` Business Nainefrypet' S9cvi0 A� �'ij 0 Previous Business on this site as Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of `�iErf vehicles, an any additional InforpiRtion thnty can ovlde; d. ca s s• *This Clearance wIli only be valid on the parcel for which it is approved. Ifyou change, intensify or move the use to a new loestion, a newZoahag Clearanoe tvJli be required. I hereby certi atl ova r ha e. i Ier s permission to use the space indicated outhis application, I also certify that tim information provided ' is true and urateto the tow dge, Ihavereadtho eonditimsofapprovai, and Iunderstand them,, and.tbat Iwill abide by them. Signature, Printed1 APPROVAWWAMATION Approved as proposed [ ] Approved with conditions [ ] Denied I ] Bacldlow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511,%117, j ] No physical site inspection fins 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, Notess Building Official Date 'I Zoning official, DateA�„� )' Other Official a Date 106U i I County of Albemarle Department of Community Development 401 Mcla(JreRon d Charlottesville, W,22902Voice; (434) 296.5832 Fax: (434) 972- 4126 Revised 7/1/2011 Page 2 of i Intake to complete the following: Reviewer to complete the Y /,Y /following: Square footage of Use: 7 / Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. / N Oermittedas: Varian e: Y/P) If so, List: SP's: F�/N If so, List: N _ ill there be food preparation? Under Section: �� .. . If so, give applicant a Health' Department form. Zoning review can not begin until we receive approval from Health Supplementary regulations section: Dept. FAX DATE. v '� Clearances. Circle the one that applies Is parcel on private well public-w�t�er? Parking formula: /bbd If private well, provide H partment form. Zoning review can not begin until we receive approval from Health Required spaces: Dept. FAX DATE Y /E) Circle the one that applies ' Is on septic or blic sewer• Items to be verified in the field: parcel Y/N Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Inspector : Date: Y / N Notes: Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # 7- -- +. nmm"ln+n +ha fnllnwina• Vio 'ons: Y/ Ifso,4 ist: Proffers: Y / Ifso, ist: Varian e: Y/P) If so, List: SP's: F�/N 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 AllministratorDeterminations or Appeals, Sign Permits, Building Permits) if Me application is not t1te owner. 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 /,8 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] Oil 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]. ignature of App i ant 0", 1/�X54A4 Print Applicant Name Date