HomeMy WebLinkAboutCLE201500207 Application 2015-10-19i'h� A[
Application for Zoning Clearance"��
CLE # 1 S Y 907k.� .:
OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS Check # 1030 Date: O � )
Receipt # 3 Skaff.
PARCEL INFORMATION t
Tax Map and Parcel: lrJ -5 Existing Zonin 6 �1
Parcel Owner; L U 1-e S `'1/ • Ilk)- � - -
Parcel Address; f.01 City i State zip�� l
include suite or floor)
PRIMARY CONTACT r l%
Who should we call/write concerning this project?
Address: q *41 &ajaxZ ,Z!i CityState ;114 Zip
Office Phone: • !�®f% Cell #��l%''y%• 1900ax # E-mail DJNAyB✓�*r �
APPLICANT INFORMATION
Check any that apply: r Change of ownerjship� , Change of use .—Change of name New business
Business Name/Type: V 1 {-Q +� I a t lemur � 049teep-
Previous Business on this site
Describe the proposed business including use, number of employees, number of sbifts, available parkiftg space number of
vehicles, and an additional information hat you can provide: Q l 6\op PL
•. 4ff �j
cos1i
*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 oym 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 ge. ve read the conditions of approval, and I,,%%understand them, and that I will abide fby]them.
Signature Printed_ /?� Y1`.CJ� r e +�• U'
APPROVA FORM TION
rl]Approved as proposed [ ] Approved with conditions
[ ]Denied
Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, 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 [ 16
i t ✓f [ S
Zoning Official Date /h 15
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 711120 ] 1 Page 2 of 3
Gist,
Intake to complete the following:
Y1E)
Is use m LI, Hl or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y 1
W illt 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 or ffc wa ?
If private well, provide Health ep ent form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic or public sewer?
Reviewer to complete the following:
Square footage of Use: 33 C)
1N
ermitted as:
Under Section; Z `/ 2 •/ —
Supplementary regulations section:
Parking formula:
�a ti
Required spaces:
Y 1�
Items to be verified in the field:
YIN
Will you be putting up a new sign of any kind? .If so, obtain proper
Sign permit. Inspector : Date:
Permit #
Notes:
YIN
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zonin to com lete the following:
Violations: Prof rs:
Y
YI
If so, ist:
If s, Mist:
SP'
Var1R ee:
Y YI
If so, List:
If so, ist:
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
AtlminislratorDeterminations or Appeals, Sign Permits, Builtling Permits) if the application is not the
owner.
I certify that notice of the application;
[County application name and number)
was provided tolei W • �` �r the owner of record of Tax Map
[name(s) of the record owners ofthe 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
ailing a copy of the application to4[wNan,,e
4 /Z
fthe record o eWthe 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].
Sign re of Applicant
int Applicant Name
l/) , • e2!i�
Date