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Home My WebLink AboutCLE201400210 Application 2015-07-29Application for Zoning Clearance CLE # OFFICE PLEASE REVIEW ALL 3 SHEETS Check # Date:, -t Receipt # Staff: PARCEL INFORMATION Tax Map and Parcel:�l/i� d(� — �U� Existing Zoning -�Qjr�p�J Parcel Owner: &,4p Parcel Address: �77o2 ✓�� Gh� 6<ly City C r'o . enf- State V14_ Zip 2Z, (include suite or floor) PRIMARY CONTACT Who should we call/write con/cerniing this project? ,oe2e_ e /ya er• G� _ _ mg Address: %// City �i��%j State G/ Zip ss � y3LI - G'o�e+•,�G,ink C2n1-2vs� Office Phone: Cell do (_� # T Fax # E-mail Cit APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of nameNew business Business Name/Type: r t Previous Business on this site 9M62yi-70AIDA, W1k 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: 1.1 OW11 I' l r(r *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 Printed AP� PbVAL AT O pproved 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 complies with the site plan as of this date. Notes: Building Official � Date� G (14 Zoning OfficialJDate Other Official Date County of Albemarle Department of Community Development 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: YN Is us LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y/N Will there be food pr ation? If so, give applicana Health Department fo Zoning review can t`�egizroHti ceive a proval from Health Dept. FAX DATE 4, l �5 Circle the one that applies Is parcel on private well or ublic water? If private well, provide Health form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that app ' s Is parcel on septic orublic sewer? Y / N aNn' \ YptS � (ofe`ai� qf r " Will you be pu ng upa new ign ofany kind? so, obtain proper Sign permit.j,� Permit# 51V \VwI,cd( EIi v -1'C -"u- Y/N �n Se XQr�ffs? 11 Will ther e ynstruc�new c on or renovatio If so, obtain the proper Permit. Permit # ZoninLy to complete the following: i 1 ns: Reviewer to complete the following: Square footage of Use: ace. J/ N ermitted as: Under Section: Supplementary regulations section: Parking formula: DCS i 10 60 V) Fa Required spaces: Y/ Item to be verified in the field: Inspector : Date: Notes: Y/ P r o ffe Ya If s , ist: Vari ce: Y/N . Ifs t: SP's. Y(N J If so, st: /i Clearances: SDP's Revised 7/1/2011 Page 3 of 3 Application for Zoning Clearance CLE # AV OFFICE USE ONLY PLEASE REVIEW ALL 3 SHEETS Checlt# Date: Receipt # Staff. PARCEL INFORMAT/I�ON �t Tax Map and Parcel: /jr(pr�) / '!� / ��() - �i/� Existing Zoning Parcel Owner: dMe -?Rohe nn / ,'/ "-- lou.+�r^ ✓per , / Parcel Address: �jo2 City�` rort_'V _f State 54- Zip 2Z (include suite or floor) PRIMARY CONTACT Who shouldwee�call/write concerning this project? Address: /o? City �P State Yr Zip i Office Phone: Cell # 5? $L,10 3 Fax # E-mail \)ath APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of nameNew business r Business Name/Type: f:�6n ILA �VW -v�*i� t Aau,(tyJ4i1 MLry Previous Business on this site (,1 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. Ifyou change, intensify or move the use to anew location; a new Zoning Clearance will be required. thereby certify that I own or have the owner's permission to use the space indicated on tlds application. I also certifythat 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 Printed L APPROVAL IXF MATION- [ ] Approved 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 complies with the site plan as bf this date, Notes: Building Official Date Zoning Official Date c Other Official /� V Date County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126 Revised 7/1/2011 Page 2 of 3 e o c 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 l AQ 011e- the owner of record of Tax Map [name(s) of the record owne s Of the arcel] and Parcel. Number 6S% Z) delivering a copy of the application in the manner identified below: ,. 9 �� x}2 , G(✓t%�) � ( 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 dZt___ _h Z 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 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]. 11711) , - = a \A ' Yaw - emat