HomeMy WebLinkAboutCLE201500141 Application 2015-07-22Application for Zoning Clearance�'��
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Checic # I ii ob _ Date:
Receipt -9 1 v S. Staff: /� $
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PARCEL INFORMATION
A
Tax Map and Parcel: �l --� Existing Zloning
Parcel Owner:01Q"� L. Q✓ cl Cavol A e S 1 I i
.Parcel Address: 07o� D BLP��Gr Dr City aeb4iesadle State VA Zipda901
(include suite or floor)
PRIMARY CONTACT
Who should we call/Nvrite concerning this project?
Address : ,Z a D a de ewr e. City o`tTG3U� State V � Zip
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Office Phone: 1 3 1 1 a0;00,% p_Cell #.2 q 9 —1 S 3:� Fax #020,2- lilt E-mail c h i Sty 1 6? 1,o f � I.
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name _New business
Business Name/Type: S+OA OrN r. C✓ a,ne� l,J�� a �� �b
Previous Business on this site r cc
Describe the proposed business including use, number of employe ber of shifts, available parking sqaces, number of
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vehicles, and any additional information that you can provide: 0 } �Le- e,,A0 A -y -e -(s ,
n ,era 04.
`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 of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them,
Signature Z/wl 4J/ Printed ba UI S
APPROVAL INFORMATION
Approved as proposed DKApproved with conditions [ ] Denied
[ ] Backflow prevention device and/or current fest data needed for this site. Contact ACSA, 977-4511, x117.
[ ] No physical site inspection has been done for this clearance. Therefore, it is nota determination of compiiai}ce with the existing
�0 40- cl✓''f e of 111,9�. S
site plan. 0CL` •�7
[ ] This site complies with the site plan as of this date.
Notes:
Building Official Date
'Zoning Official Date/
Other Official Daae
County of Albemarle Department of uommunxry iieveiopmeui
401 •McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
Revised 7/1/2011 Page 2 of 3
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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, L r 70V%,'AqCA r\
[County appli tion name and number]
was provided to I Au A �, G iAa &-to l Anor 5 di o 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
Mailing a copy of the application to LLAde--. Q ✓A j N vO I /" a or S I / I'
[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 % / 1 to the following address:
Datei le- V A
TT
/ G �
[address; writtel notice mailed to the ow er at the last own address of the owner as shown on
the current real estate tax assessment books or current real estate tax assessment records satisfies
this requirement].
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Signature of Applicant"
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Print Applicant Name
7 // o
Date
r.
A
Intake to complete the following:
Reviewer to complete the following:
Y /(@
Square footage of Use: -
700
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CPR) packet.
(g) / N
Permitted as:
, o�
Y /q
Will tiere 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
Circle the one that applies
er?If private well, provide Healthent form.
Is parcel on private well or uAepar
Parking formula:f /,
Clearances;
SDP's
Zoning review can not begin until we receive approval from Health
Required spaces: '
Dept. FAX DATE
Y/N
Circle the one that app
Items to be verified in the field:
Is parcel on septic or uJiiie seg
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Inspector:
Date:
Y / N
Will there be any new construction or renovations?
Notes: (�
If so, obtain the proper Permit.
Permit #
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ry _, a u fr.11
lionjll to COMP �ttC tvuvrruA
Violations:
Y
If s/o, ist:
Proffers:
Y
If so' -, list:
Var"I ce,
Y /, LV'.
If soist:
SP's:
Y
If so, ist:
Clearances;
SDP's
Revised 7/1/2011 Page 3 of 3
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EXHIBIT "B" FLOOR PLAN
\ , 304.2 Berkmar Drive 4 `
Suite "D"
LN
NN
10
1.' 1.
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EXHIBIT "B" FLOOR PLAN
\ , 304.2 Berkmar Drive 4 `
Suite "D"
LN
NN
10
1.' 1.