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HomeMy WebLinkAboutCLE201500188 Application 2015-09-23Application for Zoning Clearance CLE # — PLEASE REVIEW ALL 3 SHEETS OFFICE USE OALY Check #`� Date: �I– Receipt # �1 �l"3� Staff: PARCEL INFORMATION ,p Tax Map and Parcel: _6 IW i - ~� _1 o I —� Existing Zoning C �orPt•�(1n r c� 4v Parcel Owner:_Ai-r y o oeT-1;-P-s LLC, -- — Parcel Address: ,4 ,4A&dA-9 � (ie- -Sbe- M City OhQ.d State. �y j1 Zip (include suite or floor) PRIMARY CONTACT Who should we call/write concerning this project? Address: 4 2 �4 -on Ma, 4 Wl co CityLw Y.� I L46vM- State V a Zi P F ©1 Office Phone: Cell # Fax # ° "V` E-mail , APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business Business Name/Type:...� &1w;lY-Ctan Previous Business on this site Describe the proposed business including use, number of emplo ees, number of shifts, available parking spaces, number of ve 'cles, andQany additional inform^ya�tiol�n.�,that you can proyv�ide: `- ��� 43 e- '1 �V 5N KA *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 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 knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them. Signature Printed APPROVAL INFORMATION Approved as proposed [ ] Approved with conditions [ ] Denied [ ] Backtlow 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 �y Date � i 1 f e Zoning Official Date �� L e- 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/N Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. YIN 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 . If private well, provide He epartment form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE _ Circle the one that a s Is parcel on septic public Y/N Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # YIN 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: 30 g-3 (0/N Permitted as: d e L -e— Under Section: �� • Z Supplementary regulations section: Parking formula: Required spaces: % -dam Y/N Items to be verified in the field: Inspector : Notes: Violations: Y /A If silt: Pro s: YIN If s , ist: Variance: Y/'X.) Ifs , ist: SP's: Y/ Ifs6-,List: 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, 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 the owner of record of Tax Map by delivering a copy of the application in the [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]. Signature of Applicant 64 am Print Applicant Name 9 -i10 -I!5 Date EXMIT "A" stone 8p■ee "sd 1412 Sachem Place suite 100 3,083 of