HomeMy WebLinkAboutCLE201500167 Application 2015-08-17Application for Zoning Clearance
CLE # 'JO 1 � —16-1
OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS Check# 01 � Date: 8"l0-1
Receipt # t WC13ck Staff:
0
PARCEL INFORMATION ?�Ckvlv),23 1D•2v.2 tug
Tax Map and Parcel: 7
1 L� Existing Zoning
Parcel Owner: )4-t ` 1 c,(—,as4-
C
Parcel Address: �a A'G%U,CP--Ctsbre ¢( ityr_F{�2iO a���a(� tate A(I$ Zip
(include suite or floor)
PRIMARY CONTACT , ! AJ670
Who should we call/write concerning this project?yN
Address1LL(en 1>e_� J�eityC�+R21� i s�(tate Zirb2agO
OfficePhI# E-mail ni6W6L0C-A-S1'1 r' GIndii �I
APPLICANT INFORMA TON
Check any that apply _Change of ownership a t5e-� Change of name New business
Business Name/Type:
Previous Business on this site 5i9 J\CE:- A S A t3a V s=
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
icles, and any additional information that you can provide: Uri U, Rrc OS,- `
`7 z2 -�3rclu CI
`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 tha I wn 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 t 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)�G
APPROVAL INFORMATION Denied
Approved as proposed [ ] Approved with conditions [ ]
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-451 f .o 17.
[ ] 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
Zoning Official Date
Other Official Date
_.
County of Albemarle Department of CommunityDevelopment _ .
-
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 rax: (434) 972-4126
Revised 7/1/20.11 Page 2 of 3
take to complete the following:
Y/j��
Is use n LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y7
Will there 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 r puller?
Ifprivate well, provide Hea.Lthl�ment form.
Zoning review can not begin until we receive approval from Health
Dept, FAX DATE
Circle the one that a li
Is parcel on septic o public 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 #
Reviewer to complete the following:
Square footage of Use: & IV/ LO)
9/N -I
ermitted as: _,,jj/S
Under Section: Q Z
Supplementary regulations section:
Parking formula: �S
v�
Required spaces:
Y/lQ
Item o be verified in the field;
Inspector : Date:
Notes:
Zoning to complete the following:
Vio tions: Proffers:
Y/ N
Ifs st: so, List:
Variance: SP's:
/ N (/ N
so, List:
so, List: ,LL 6� 2�
Clearances: 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 (Hone 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 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
[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].
Print Applicant Name
yg%?ozIS
Date
L1