HomeMy WebLinkAboutCLE201500123 Application 2015-07-13Application for Zonin Clearance
4D
CLE # 2 d) 1-_I_F
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OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Receipt # Staff:
PARCEL INFOR�TION / O 1 7C [
-7(7 00 ` 60 06
Tax Map and Parcel: �G2( -�� Existing Zoning
r n`' S �eq 4
Parcel Owner: �P
Parcel Address: 73 101 F041 6?(Il e /;)f City —V; (de 'State-v'14 Zip
(include suite or floor)
PRIMARY CONTACT _---�'' _)
[' `� �1 C, e ' d Zeno;,
Who should we call/write concerning this project? -> > G� , (
Address: �S� ��� Ze� ' `� 2 City C /'d z L State Ll /7 Zip �� -3
Office Phone: (K ` Fax # E-mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
'117 CJ r �' S �� �-1 ' " �� _j_9 C
Business Name/Type:
ite
Previous Business on this site—
dol
Describe the proposed business including useVnt�mL of employees umber of shifts, available ices, number of
e- f
vehicles, and any, additional info -y�tion that you can. provide: P) CH cvt
- r.
*This Clearance will only be valid on the parcel for which it is approved. I u 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 of owledge. I have read the conditions of approves( I .understand them, and that I will abide by them.
Signature
APP AL INVORMATION
[VApproved as proposed [ ] Approved with conditions [ ] 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 c li with the site Ian as ofthis date. ..
'�
Notes: <
Building Official Date f tS ("c
Zoning Official Y-LDate I
Other Official Date _..
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434)972=4.126
Revised 7/1/2011 Page 2 of3
Intake to complete the following:
YN
Is in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/N
W' re be food preparation?
If so,
ve 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 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 # G'e't/
Y/N 1
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit#
7nnino to ommnlata tha fniinwinvt
Reviewer to complete the following:
Square footage of Use:
Y)/N
Permitted as:
Under Section:
Supplementary regulations section:
Parking formula:Vs q
C ,V#Yil dA
Required spaces:
Y/N
Ite to beverified in tIr, field:
Inspector • Date:
Notes:
Violations: v
Y/N
If so, List:
Proffers:
Y/N .
If so, List:
Variance:
Y/N
If so, List:
SP's:
YIN
If so, List:
Clearances:
SDP's
Revised 7/1/201.1 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,-Z617�'t �I C'� "C�
[Coudy application name and number] �d`/
was provided to (r i n k ty Fe, the owner of record of Tax Map
[name(s) ot thd record o4vners of the parcel]
and Parcel Number076 00 00 —CC'S l % G 1 by delivering a copy of the application in the
manner identified below: r
Hand delivering a copy of the application to (4 g 1I has �o'r
[Name of the record owner if the record owner is a�
entify the recipient of the record and the recipient's
person; if the owner of record is an entity; id
title or office for Oat entity]
on G ! 0 2100
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].
SibAre of AKPlicant' r; ..
r') din t1 r
Date