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HomeMy WebLinkAboutCLE201500190 Application 2015-09-23Application for Zoning Clearance CLEfi!30\'3-- Mo I& � OFFICE USE K • ONL, ! 6_ � PLEASE REVIEW ALL 3 SHEETS Check # Date: Receipt # l0 1 "A qT Staffs PARCEL INFORMATION l Tax Map and Parcel; T M i� ! E�'' Existing zoningPan di 1�eV. M/XEb �+ D �EMf2r�ip, LLQ Co�rrr�es,¢crgv Parcel Owner: lT�or a e, Parcel Address: 4-91 15e,rkma.r C+: iv City G�Vl 1'C State VA Zip 229-01 (include suite or floor) PRIMARY CONTACT� Who should we call/write concerning this project? �a 1 DwG S' A.}" �` p Address : zb4 t SDS, GVA 15 U City A%erA 6a rdat state Zip 1:2959 Office Phone: ( } 14A Cell # 154-467--NaVax # 9A E-mall dabra�dof �naifl• �' APPLICANT INFORMATION Check any that apply: Change of ownership� Change of use Change of name New business BusinessName/Type:i o � (LC�L64t)me- NUSSac — Previous Business on this site+'��_ a n oyte- jc�9 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:S e .arr t r rie-4DCS+ r ark. i o �1 t d •h' a ,`rr i *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 owner's permission to use the space indicated on this application. I also certify that the information provided is true and accurate to the best of my knowled I have read the conditions of approval, and r I understand them, and that I will abide by them. Signature Printed )o !o reg A . B slain /o 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 � Zoning Official Date Other Official Date County of Albemarle Department of Community Development 40I McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126 Revised 7/1/201.1 Page 2 of 3 Intake to complete the following: Y/N Is use in LI, HIor PDIP zoning? If so, give applicant a Certified Engineer's Report {CER} packet. Y/N0 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 o ublic wate If private well, provide Heal epa ent form. Zoning review can not begin until we receive approval from Health Dept, FAX DATE Circle the one that appli Is parcel on septic or �tblic sewe Y /O Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Y/© 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: 12. f X 12t 6y&t D/ N -- 'Permitted as: Al of e tel � Pi �- Under Section: :7-5A , J Supplementary regulations section: Parking formula: Required spaces: 2. Y/N Items to bg verified in the field: Inspector : Date; Notes: Vial tions: Yl If so, List: Proffe : Yl If so', -List: Varia e: Ylt If so, List: SP's: YI If so, List: ClenAnces: 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, TDUCt{Td/vE ,XV9,464rE [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 b1 Ai " 1,;t -I&P- by delivering a copy of the application in the manner identified below: Hand delivering a copy of the application to -4 " WWI "G [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 q 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], 5iTtureo of Applicant (o v -e-5 A • Fra. kda /D Print Applicant Name Date Cora -7 40 )C3y n�L � LLC