HomeMy WebLinkAboutCLE201500174 Application 2015-09-03Application for Zoning Clearance
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CLE # 15—!!
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PLEASE REVIEW ALL 3 SHEETS
OFFICE 99T,
Check# Date:
Receipt # i b 1 OM Staff: 2
PARCEL INFORMATION
Tax Map and Parcel: 0(.1 V0 - 0 3 -Ori- 01 g h0 Existing Zoning N f �1
Parcel Owner: Sin IMG r" f c t d
ParcelAddress:xn7s P'�J St• Sui+c NO City Qierlo++4y711C State VA Zip Z2?01
(include suite or floor)
PRIMARY CONTACT
Who should we caIl/write concerning this project? P icl,ia of;—,a,
Address: 3955 7NwK+S Gam• City Nsal. UW JT -J State 11A Zip ?'z?_S9
Office Phone: N34 ZlS--2z73 Cell# 531-6ZeS Fax E-mailA'4hiz 011'y",r
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: 1 he • fHe Ugm
Previous Business on this site NIA —
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: bim b, JWJ s ; i c -44%.g
*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.
1 hereby certify that I own or have the owners permission to use the space indicated on this application. I also certify that the information provided
is true and accurate to the best o/f� my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them. 3
Signature - /� ' Cl^r� .rte Printed A. 01;4
APP VAL INFORMATION
[ pproved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 9774511, xl 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 l �z _
Zoning Official Date V�< lie
1
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/ kN j
Is us m LI, HI or PDIP zoning?
Engineer's Report {CER} packet.
If so, give applicant a Certified
YIN
Will � re 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 orp �c wat
If private well, provide Healt ent form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE _
Circle the one that apt!!�O
li
Is parcel on septic or
YIN
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit, q
Permit #
"'/N
'Will there be any new construction or renovations?
If so, obtain the Drnner Permit.
Permit # _
Zonintt to complete the following:
Reviewer to complete the following:
Square footage of Use: _ 3,100
Vted as: h1h ( 6-0 'i ut
Under Section: d0 k Q AAWYYIc, j[ e b� a s
Supplementary regulations section:
Parking formula: 'i� . T6/10
6i 0 0 D
!! 1 9
Required spaces: G
Y I �J
IterrVo be verified in the field:
Violations: �
Y/N
If so, List:
r ffers:
Y I N
4Yso, List:
Variance:
Y/N
If so, List:
SP's
Y/
If so, tst:
Clearances:
SDP's
Revised 7/1/2411 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;
was provided to
[County application name and number]
[name(s) of the record owners of the parcel]
and Parcel Number
manner identified below:
Hand delivering a copy of the application to J � M { S L3K / /yy,(-
[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]
the owner of record of Tax Map
by delivering a copy of the application in the
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].
ature of Applicant
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Print Applicant Name
Date
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