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HomeMy WebLinkAboutCLE201500172 Application 2015-08-31Application for Zoning Clearance `t' CLE # ti 1.S — 11�k, a„;t 4�1tf11N"� PLEASE REVIEW ALL 3 SHEETS OFFICE USE ONLY Check# 1 a Date: Receipt # to -1 og 6 Staff: PARCEL INFORMATION (/��� f Cc — 173 '?1 CNnn 1}ee1 Slew Tax Map and Parcel: t Existing Zoning "_f Parcel Owner: 5� N\,o 1J R 1: 12.7-(c S 1 .Ptce— 13 Parcel Address: 1553 1\�© e(DA-D E&SS 'City0—RAeW�VZ-V1L1_CState \Z.A Zip22`�O1 , (include suite or floor) PRIMARY CONTACT I Who should we call/write concerning this project? S u tt 22 � Zip 01,5j0 I Address: lCA,S d L'-rtf D CSL S -F City (No (3; kA,t State�II k i Office Phone:( ) o'I-!�3�( Cell#50932414-x(0iax#_W0gQ763(vZE-mailb�C-6("5Lint,OJVEKV(”-C APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name �i'New business Business Name/Type: �3E= W S_MRt.- PA' s -H i o !J Sia L284g — Previous Business this 1� 1u S F} on site�� ,('rte- 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: .8T! -V— VIAL(, Hp o t'L 5 *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 haye owner's permissiAtuse the space indicated on this application. I also certify that the information provided is true and accurate to the best f y wledge. I havee conditions of approval, and I and rstand them, and that I will abide by them. Signature r� Printed . L V if A -11/k APPROVAL INFORMATION 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 , I -i ( ( Zoning Official Date glul'_961_5� Other Official KJ Date County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126 Revised 7/]/2011 Page 2 of 3 M., .:)(A Intake to complete the following: Y/ Is us n LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y / Will t ere 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 ofc ter? If private well, provide He Fr rtm Iaent form. Zoning review can not begin until we receive approval fi•om Health Dept. FAX DATE Circle the one that applies Is parcel on septic or is sewe . 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: �/ qj /N ermitted as: icft, I Under Section: Supplementary regulations section: Parking formula: �� Required spaces: Y/N Items to be verified in the field: Inspector : Date: Notes: Viol ions Y % If so, ist: �roffers: (Y) / N so, List: Var��ce: Y /3�-� Ifs ist: SP's: (� / N If so, List: 2 d2 Clearances: SDP's Revised 7/1/2011 Page 3 of 3 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, ATAT [County application name and number] was provided to SJM-01- `C (� o �(z- , R—j—t L 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 �Ivkof3 C (2 [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] onR1 `J— to the following address: Date [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]. 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