HomeMy WebLinkAboutCLE201500135 Application 2015-07-10Application for Zoning Clearance
CLE # 0 kS — i 35
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # (,C�s V-\ Date: G
Receipt #` "7 Staff: �4S Z
PARCEL INFORMATION 2 n p `//fin
Tax Map and Parcel: ow —"q3- DO.- bl -I 1 � Existing Zoning_ �I PI/1 0
Parcel Owner:
p '
S�, 5"'te i10 City ' 1jyk�-\ `S��&ite\ y A Zip,33go1
Parcel Address: x630 � on1 \ ,
(include suite or floor)
PRIMARY CONTACT / 1
Who should we call/write concerning this project.
Address: 6 0 Saws] rass P'V. City QMx' tmecw t WQ,State V 1 \ Zip 9,990
Office Phone: Cell # �- � �� 1('ax # E-mail &16 _jMu11Leesoj�
CNaV lQk�eSui llc� Ccw�
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: AAMIos
Previous Business on this site -1ko nd on -S
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:
*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 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 acc ate the best of my :owledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed
APP OVAL INFORMATION
[ Approved as proposed [ ] Approved with conditions [ J Denied
[ ] 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 of compliance with the existing
site plan.
[ ] This site complies with the site plan as of this date.
Notes:
Building Official Date
Zoning Official Date 15
7j
Other Official Date
County of Albemarle llepartment of c.ommiuury "eveiupruen!
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
Revised 7/1/2011 Page 2 of 3
U
Intake to complete the following:
Y/N
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y IN�
Will here 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 ublic 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 ublic sewe
Reviewer to complete the following:
Square footage of Use: fg66
/N
-mitted as:
Under Section: MLl"1
Supplementary regulations section:
Parking formula: % 6 0)
I �V
Required spaces:
Y/N/Ite o be verified in the field:
YJ/ N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit # 6� b 1 �5 ` b Q� Inspector
N Notes:
ill there be any new construction or renovations?
If so, obtain the proper Permit.
Permit # f'o'ol 015— 99--�01 AC
_�_.._ ..L ,, r.. ��,.._.:...�.
D ate:
uv A. al w v
Vio ons:
YN
If s ist:
Proffers:
Y/N
If so, List:
f
Variance:
Y/N
If so, List: �
's:
/N
o, 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
AllnlinistratorDeterntinations or Appeals, Sign Permits, Buil(ling Permits) if the application is not the
owner,
I certify that notice of the application,
[County application name and number]
A��ermar�e Place C-ftAIP LL -C,
was provided to 1 VV _ urn- 61 q A-0 the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number' �' _� GQ by delivering a copy of the application in the
manner identified below:
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
fill epnay�t.Place En�P ��c,
--�,-/—Mailing a copy of the application to 1� 1c��5 �\ 1 I �1�; ��i' 1 �� L E "D ` '
[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
officefor that entity]
]f
on V 15 to the following address:
Date
1 4�, � 00
[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].
Print Applicant Name
Date
f b Dfi(�
mba081V
Hal Iwaj
Cl os cf+
SmRM
nwm
41
NONNEfS CPAMOrfFSYIUE PIOOR PLAN
srx . f -0
CP
A -1` S- H
s}oG,--obrn
\C� �,St�k
�tk-&O W3,0—,
1 '�33 5tk
EOnOO8d wNOLLVOnn MS3001nV NV A9030nOONd
p 0 o
HaIIwa
1 Os �f•
Fo��a�e
tY-6'
s -s' tY-C
STORM NVA IPFTP C�9fl5 F1tL
PRWC
Ai1tC 6•
0
Elm-
s
If4lY
S
9N
T�
lr
b
s Oq
�._ .
o[O H §
,au
214
S= RDDU
- §
s -e• L r_Y r -c
U
O
fA�lf1]
N Wl WTAq
O ASWq b
O MRI O.N[VI NIISf. RI]I
� Y1R1 CISfiNI
a it -z•
a
m
w
aR7LYE o5wrr T
1/8fE
Y -C
5.-q.
5•-0'
B
i •
b
Z
O
O
T
R0110 O�IAY � ..
TIAL
vs\
i /�
09W SPNE
LIO KEES CRAMMTESALLE FLOOR PUN
,,'. - i -0
v
orn
St�k
) 33 5
1OF1008d IVNOLLV0003 MS3001OV NV AS 030T100Nd