HomeMy WebLinkAboutCLE201500164 Application 2015-09-10Application for Zoning Clearance
CLE# QplS-_ 164
PLEASE REVIEW ALL 3 SHEETS
TOFFICE USE ONLY
Check # 1(�a LA Date: -7-- } -1
Receipt # l uCK , 3 _ Staff: I A-5
PARCEL INFORMATION
Tax Map and Parcel: —) CIE �A Existing Zoning �--��-
Parcel Owner:
Parcel Address: Z %A: t Rev, City Cka,r)64+6y111x_ State—VA -zip-z"11
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project?
Address: i� i 1 0".i i-tA "[u.r]b44ef,r'}
City .........- --- �-- State _u� Zip
Office Phone: ( 3q) S'6&-_?-" S Cell # c9 - 1- Fax # E-mail rk._nt�a
APPLICANT INFORMATION
Check an -
,y that apply: Change of
of use Change of name New business
BusinessName/Type:
Previous Business on this site
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: 1 o;*r,'cA, , f: �1.:, � � "[� ti � °.� �. �•, .:1 �t,, ..
*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 1 own or have the oar's permission to use the space indicated on this application. I also certify that the information provided
is true and accj�xalctt� the best ofyw k
h6r,.do5A have read the conditions of approval, and I understand them, and that I will abide by them.
S ignature _. _ .,, s _ _-'' Printed . 0.n:. &s f l n,Je_
s
4APP
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
Zoning Official
Other Official
Date '''f1(_� (-(- �'
Date
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:
Q/ N
use in LI, HI or PDIP zoning? if so, give applicant a Certified
Engineer's Report (CER) packet.
Y/N
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 or lie ter?
If private well, provide Heal ent form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applie
Is parcel on septic or
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 followinw:
Reviewer to complete the following:
Square footage of Use: _�
P�/N
Permitted as: D t�
Under Section: Z-4
Supplementary regulations section:
Parking formula:
�aJ
Required spaces:
Y/N
Items to be verified in the field:
Inspector: Date:
Notes:
Viola ions:
Y l
If so, t;
ProtT+� s:
Y /(4 J
If so, ist:
Variance:
Y '
If soest:
, L
Yl
If so, is t:
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.
T certify that notice of the application, � `^ r' L� ea`s,,14v
�/ [Cou ty application name and number]
� l�
was provided to —P G�6wlc� the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number { � zA Qw)A R -L" (-LAA$v 1%y delivering a copy of the application in the
manner identified below: VA iL� ll
✓� 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],
J _
Sign9ure of Appli t
Print Applicant Name
Date
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ALBEMARLE COUNTY, VIRGINIA