HomeMy WebLinkAboutCLE201500205 Application 2015-10-19Application for Zoning Clearance.
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CLE -9 a Q I S !_
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONL
Check # VD53 Date:
Receipt # 101'30' Staff: — :NS
PARCEL INFORMATION
Tax Map and Parcel: -^I / J 2 Existing Zoning
Parcel Owner:aTT ��le Li�r•�
ress: � � Y t :i �City { STT 64 State Zip' Z-7,96
Parcel Address:
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? M&g , Ak
1%/1
Address: A4A Zkir 2rZkVT— City C %/ w&o State NOE
44& 454 -
Office Phone: 517-24&0Cell # • 4irAZFax # J31_J° e7G ' E-mail _WIC ♦ �%i[ �Ir t+ytfi+�'�"
)(107, 60 V! tTi,a iftn� .
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
ff�P, FOO -e -ter
BusinessName/Type: �1QLLAJ.
"
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: CX- �!, 3�
AT.
J&W, ' To N W *,1JF, rA J x cu .I rI � a �
*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 +e�L
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.
Signatur' Printed hilk,�� _
PPROVAL INFORMATION
Approved as proposed [ ] Approved with conditions [ ] Denied
[ Backflow prevention device and/or current test data needed for this site. Contact ACSA, 477-4511, 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.
Building Official
Zoning Official
Other Official
Date !0 l`t� e
Datc�%9�7��5 _
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:
Reviewer to complete thee (following:
✓� ���
Y 1 N
Square footage of Use: _
is usLl, HI or PDIP zoning? If so, give applicant a Certified
0 1 N
Engineer's Report (CER) packet.
Permitted as:
W it ere be food preparation?
Under Section: ,
if so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from Health
Supplementary regulations section:
Dept. FAX DATE
Clcarances:
Circle the one that applies
Parking formula:
Is parcel on private wet r public wa#er9
If private well, provide ment form.
Zoning review can not begin until we receive approval from Health
Required spaces: j_3
Dept. FAX DATE
Y 1
Circle the one that ap dies _}_
Items to be verified in the field:
Is parcel on septic ublic sewe
YI
1 you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
inspector: Date:
Permit #
Notes:
Y N
IIIthere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zonin to com tete the following:
Violations:
Y16
If so, List:
I
Profs:
Y
If so, List:
SP's:
s,
If so,ost:
Vara ce:
Y 1(f
If so, List:
SDP's
Clcarances:
Revised 7/l/201 1 Page 3 of 3
CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
This farm 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,
[County application name and number]
was provided to 4"if.P4 *.JaAtj 4000W the owner of record of Tax Map
[name(s) of the record owners of the 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]
r)17
Date
/Mailing a copy of the application to
0vtW14ftj + jr.249
[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 1 of i*- VAC21 �07 to the following address:
Date P, p, V;C�P4
[ Hca r-fJe4A IJ 'Giz11%Ie CAA .1., rl, ✓h-
[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
*Aram.
Print Applicant Name
'v/14z hzol G,p
Date