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HomeMy WebLinkAboutCLE201400226 Application 2015-07-29Application for Zoning Clearance1''F:', CLE # LOig — ZZ�x� �Yltr;IN�' PLEASE REVIEW ALL 3 SHEETS OFFICE rERLY Check # Date: - Receipt # Staff: PARCEL INFORMA IO Tax Map and Parcel- 0 ` Existing Zoning � t Parcel Owner:— to c �l (— �— Parcel Address: (') ���Q ��P IQ ! 4 .� City l � Pip �Sv t 1 4Q State I, Zip (include suite or floor) PRIMARY CONTACT �j { P 0 Who should we call/write concerning this project? v �4� r` V Q, Address: ��� (��2Qv�� 2I �( City l_LJ1,1u_State V Zip U96 J Office Phone: LCell # 4,34160'LSA � Fax # E-mail 1 APPLICANT INFORMATION Check any that apply: Change of ownership of use Change of name New business jChange Business Name/Type: ©QEK k,,Co f-Por (Qd l U%T 4\ (oast t,, e-..% c.0 S-1-0 (-',Q Previous Business on this site f`0, C C 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 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 un�st nd them, and that I will abide by them. 1/v� C V'ee 9L, � Signature w� �iG� Printed 1 V AP OVAL INFORMATION [ Appro d as proposed [ ] Approved with conditions [ ] Denied [ ]B flow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, x117. [ o physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing site plan. [ ]This site comp res With the site_plan as of this date. p _' j Notes: t 1. k'1 V Building Official Date (j� \4-i ii Zoning Official i AIN A Date 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: Y/N Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. _Will re be food preparation?z>' 7f so, gFv-e-`a-pFri-c-a6F-a-FreaTtF Department fo Zoning review can not begin until we receive apprkl ro healt 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'. lic sewer Y/N Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Y ill%het€be an new construction r ren i W y w0 renovations? If so, obtain the proper Permit. Permit # Zoning to complete the following: Reviewer to complete the following: Square footage of Use: V P€r)mitted as: E( J S- J Under Section: -1 L 0 Supplementary regulations section: Parking formula: )Ldo 6�-� Required spaces: I S Y/N Ttamc to hP varifip.d in the fudrl- Viol i:i s: If N� Ifs ist: Prof rs: Y / If s , ist: VY ari ce: Y If s,ist: `VN o, List: , ^ 1 U�/IV IA- _ Clearances: SDP's Oe Revised 7/1/2011 Page 3 of x 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, _ I ''"f — ( ( "(e (e [County application name and number] was provided to [name(s) of the record owners of the parcel] and Parcel Number manner identified below: the owner of record of Tax Map by delivering a copy of the application in the �C 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 [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]. Signatur of Applicant tu V / 0. 1��vo Print Ap cant Name //f3/I 4 Date