HomeMy WebLinkAboutCLE201500222 Application 2015-11-03Application for Zoning Clearance
CLE # _QD_U57 �'�
urrt� r L
PLF,ASE REVIEW ALL 3 SHEETS Check
Receipt # _
ON I"
Dale: 0'
R ;;_0 staff:
PARCEL INFORM AT Q 7 �,- /t} ;,; Existing "toning,_
'Fax Niap and Parcel:
Parte[ Owner: ' l r,' A► r, ,_j
Cite _ tate
Parcel Address:
(include su to or ftcor)
PRIMARY CONTACT�4— _
Who should we cail write concerning this Project' G � i�
COP
}UA p4D Zip
(„) CO t ~ > l
J State
31
Address : City 1 %rtlJi
Cell 'v) 4' FAX # _ E-mail .�
Office Phone: � � -�
�nnr irAfkft INFORMATION
Check a
that applq: Change of ownership Change of
~* •AM AI. <P1fug
Change of name
a�-
Business Namefrvpe:. ] '
Previous Business on this site
Describe the proposed business including use. ntttnber of em
Lehicles, and any' aticlitional fnfolWation that you cangrov d
business
number of
Chi: C'le trctnu will (1111) he tialid +�n the parcel iitr ultieh it is a pr�)Ned. 1C}nu change. inten�ii� or inme the MA! it' a IUM I,]cnlitnt, a nen /.doing
t,'leurauice hill he required.
1 herob} certifi that I t /_1_9k
space indieulcd on this vrlleati.m. I .t[ t eenif% th:u the inlimnallon pro ukeui, true and accura t c hnditions ofapproval. and i nndersunui theca. and that I %%ill ahide h} (heir.
1 o�..,..l9ANDY K��SI_.
Signature
APPROVAL INFORMATION
Approved as proposed [ J Approved %xith conditions [ } Denied
[ J Bach low pre%ention dtvice and:ar current test data needed for this site_ Contact ACSA. 977-4i 11. yl 17.
J J tics physical site inspection has been done for this clearance. "1 herefore. it is not a determination ofcompliance with the existing
i
site plan.
J } rhis site complies with the site plan as of this date. !
]Votes;
Building Officia 4 C Dttte
Zoning Ofl"ttial Date
i
Other Official Date i
i
County of Albemarle Department of Community Development
401 1%lei ntire Road Charlottes-. ille. VA 22902 Voice: (434) 296-5832 Fox: (434) 9'72-4126
Retiised 7 12011 Pago 2 of -1
Intake to complete the following:
It'
Is us n l.l, Hl or PD1P zoning': if so, give applicant a Certified
Engineer's Report ICER} packet.
Y
Will there be food preparation?
Ifso, give applicant a Health Department form.
Zoning revieW can not begin until we recci%c approval from Ilealth
Dept, FAN DATE —
Revieiver- to complete the following: -
i Square footage
'Permitted as:
Under Section: I r --
SupplemenLinregulations section:
Circle the one that applies Parkins; formula:
Is parcel on pritiate'el 6r:P1
DIA"
ifprivare well, provide lott form,
Zoning review can not begin until we receive approval from I lealth Required spaces:
Dept. FAX DATE
i
Circle the one that appl' I ]tens to be %eritied in the field:
Is parcel on septic or u Ilc ie r" i
I } : N
Will you be putting up a ne,,% sign of any kind" If so, obtain proper
t Sign permit.
Permit # Inspector : Date:
Will there be anti new construction or renovations" — — If so, obtain the proper Permit. -- — - - -
Permit #
Zoning to complete the following:..._.--.
Violations: 1 Proffers:
!
if So. tsr I If so, list:
Vari ce. SY's•
!.ti• I S
1fSOY St., ifs4Y, ist: �
i
i
I
Cizarances: SIM"s i
�� la 9 --itis
Revised TI:2011 Page 3 ni` i
CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
This farm must uccotttpmt}, zoning upplicutions (Honre Occupation, Apting, Clearance. Aning
Arintiuistrutor Determinations or Appeal.v Sign Perinits, Buililin Permits) {f the application & rtof file
owner.
1 certify that not ice of the application, _F, o
[Count,, application name and number]
� Cr
was provided toTjq6 MM -W ftbcig..Of VIP: -(2 IJkhe owner oti record of Tax Mat
Inaame(s) of the record o�iners of the parcel
and Parcel Number V 18 V —g5,,5&6b� dcli,,ering, a copy of the application in the
manner identified beloxv:
Hand delivering a copy of the application to V,v� v �►��
[Name of the record owner if the record o" ner is a
person, if the owner of record is an entity. idcntif�,• the recipient of the record and the recipient's
title
�"o}r(office for tjhaat entity]
Date J
Mail ing a cope of the application to
INitne of the record o%%ner 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
offiicc for that entity]
iE
Date
to the follo%%ing address:
[address; written notice mailed to the oti,.ncr at the last known address of the owner as shorn on
the current real estate tax assessment books or current real estate tax as;esstnent records satisfies
this requirement], e� ►
� d
Signature ol'Applicant
Print Applicant Name
0 r
Date
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SI_G_NATURE:DATE: 3.740 - - SO FT
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WALLS INTERIOR FACE OF EXTERIOR
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