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HomeMy WebLinkAboutCLE201400206 Action Letter 2015-07-29Application for Zoning Clearance CLE# � OFFICE U NLY ` PLEASE REVIEW ALL 3 SHEETS Check # Date: Receipt # 49SX1 Staff: PARCEL INFORMATION , j G ry �Q Tax Map and Parcel: I p 4N Existing Zoning ,A & u Parcel Owner: Parcel Address: yi� e 11te?l11 6 1 (include suite or floor) PRIMARY CONTACT p Who should we call/write concerning this project? llil �—�.�/-� Y z a +M r Address :qq,lp� 9 /°'rl/ /LPtY OLjll e V"�i't �; � � , , y� Office Phone:q ell # Fax # ��elE-mail 12P. APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name )( New business _ 15 Business Name/Type: `11�E;:,L' T/cam 1 &L•L1Y Previous Business on this site Describe the proposed business including use, number of employees, u ber of shifts, available parkin sp c, number of vehicles, and any additional information that you can provide: �) *This Clearance will only be valid on a parcel for which it is approved. If you change, intensiff 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 aggplicatio I also ce ify that the information provided is true and accurate to the best of my kno ledge. I have read the conditions of approval P under and them, afid thal I will abide by them. / L Signature (/1/ Printed AP OVAL INFORMATION [k/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 of this date. Notes: Building Official Date t ©r r `e Zoning Official 7 4JUji P, d iuu Date 11 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 'Y y Intake to complete the following: Y/ Is us LI, HI or PDIP zoning? Engineer's Report (CER) packet. If so, give applicant a Certified Y / Wil(De 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 pCea er? If private well, provide Healthent 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 or ublic sewer? Y/N Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Y/N Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # Zoning to complete the following: Reviewer to complete the following: Square footage of Use: 1--G� U��N itted as: _ Under Section: Supplementary regulations section: Parking formula: Required spaces: Y/N Items to be verified in the field: Violations: Y/N If so, List: Proffers: Y/N If so, List: Variance: Y/N If so, List: SP's: Y/N If so, List: Clearances: atly�mac �tX%11(� ('.f�� SDP's Revised 7/1/2011 Page 3 of 3 I. , 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] I was provided to.. the owner of record of Tax Map names) of the recor owners of the parcel] and Parcel Number manner ntified below: by delivering a copy of the application in the r /� Hand delivering a copy of the application to I-- (d.�' 3-- [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 en ity] on /-) a 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]. J� x57 y Signature of A icant r /ZZ- 7�ca Print Applicant Name Date m 0