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Home My WebLink AboutCLE201500143 Application 2015-07-100 licatIon forZoning Clearance CLE # ca0 l � - t''t PLEASE REVIEW ALL "s SHEETS Or FICE USE ONLY i o — l Clleck # S6 e( Date: -7- Staff: Receipt # PARCEL INFORMATION, Existin Zoning Tax Map and Parcel: I� l_ &D g g l 1 p LL Parcel Owner: �� Vy Ot9� ��UV�—° ` L Parcel Address: a33 Nyaravt�i Ri�% City C6 lo�l!i �CState Vo-_ Zip 10/ (include suite or floor) PRIN1ARY CONTACT � \J eJo r it C Q\rte 2 Q Who should we cal;/write concerning this project? i� �tt� -- U Zip ' !�`1 ��O Fax �_-'st^.r-s't'{ail. dtl e CSID AE • ne. I Office Phone: (_) Ce,l # �' P'a,. # IV _� I �g37 A—PPLICANT aNFO;LNIA.TfON CE It any that apply: Change of ownership Clrrl_ge of use ^hangs of Warne l�Te•�v business „ N 1n Business Narne/Type: QSSge' e Previous Business on this site 7" Ct. !HLA Describe the proposed business including use, n€€ -tuber of employees, number of shifts, available parking spaces, number oin _R\.. $ am ` S �LC vehicles, and any additional information that, can provide: e.- Wane + Ct.et, 5141te* 4-o a �eu�se o r - C��rS - 1��-r, + c- P–I& wecK PA Ten "This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move t1,e use to a new location, a new Zoning Clearance will be required. 1 I hereby certify that I wn 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 t he best of nIy In ledge. I have read the conditions of approval, and I understand them, and that I will abide by them. i� Cgcra��a� SiguatLre rented_ � A'PR0"VAL INFORMATION Approved as proposed [ J Approved With conditions [ ] Denied [ I 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 ox compliance with the existing sae plan, [ j This site complies with the site plan as of this date. Notes: Building OfficialDateAl� Zoning Official Date 7/h)Llc)l Other Official —_-- Date -- 'County of Albemarle Siepa.rtrrler Eol %_01 ILUJIlLy ucVcJVF 401 Mclntive Road Charlottesville, VA 22,902 Voice: (434) 296-5832 Fix: (434) 972-4126 Revised 7/1/2011 Page 2 of (CIA Intake to complete the following: Reviewer to complete the Y / ) Is uAh LI, HI or I'DIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. /following: Square footage of Use: ? SO 0/ N Permitted as: Allqj; cA l Y/ Will there be food preparation? Under Section; �� Z If so, give applicant a Health Departtnentform. Zoning review can not begin until we receive approval from Health Supplementary regulations section: Dept. FAX DATE r Circle the one that applies Is parcel on private well oruGhc'�va r? Parking formula: If private well, provide Heal partment form. Zoning review can not begin until we receive approval from Health Required spaces:i Dept, FAX DATE Ofs: / N If so, L'sst;�� Y N Circle the one that ems to be verified in the field: Is parcel on septicubIic�sewe► Fp 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? ff so, obtain the proper Permit. Clearances: Permit # SDP's AJVSS t26 LV VVif.> J Violat'ons: Y/ If so, List: Proff�e,�s: Y/�`'/ If so, List: ' r Yaris ce: Y If'so;List: Ofs: / N If so, L'sst;�� 0 Clearances: --^N 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 the owner of record of Tax Map [name(s) of the record owners of the parcel] and Parcel Number manner identified below; 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 Date . _V/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]. Signature 4Applicantss Print Applicant Name Date J 1 d 4 A - Gr cr, QN