HomeMy WebLinkAboutCLE201500216 Application 2015-11-04�lP�1s Flue 611/ �10W AIZ CI 4 Ca" 106 - Irz 5z o
Application for Zonin learance:'
CLE # ('� aS —
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USENLY
Check # H 6 T Date: 9 o -Q ` I
Receipt # ! U I'l 73 Staff.
PARCEL INFORMATION 20 2 o a
Tax Map and Parcel: 0 786 O - d / • a a � / G O Existing Zoning � � C' b 1M � e 12 c 14 L
Parcel Owner:' ` l li cR rS 1- - '. .
Parcel Address: 326 /�dfw, �tiJee cityeA11R(64eSJ<<4- State I/ JW Zip Zz9I
/10/ / (include suite or floor) Z z
PRIMARY CONTACT ++ .. '' LL
Who should we call/write concerning this project? <4 W k l• ! Lt PPV t L L Gl�
Address: 5 d i City W 1) W CLLA k-[ G State 1 73p E3 202.
Oliice Phone: '17ti -•n 71 Cen OW) -772 207 JFax # E-mail S r" , W ljt+-t
APPLICANT INFORMATION
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Check any that apply: Change of ownership Change of use Change of name New business
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Business Name/Type: .J ci A N Sb m (r b I� 4ie6t S X �-•
Previous Business on this site V 4C I4IV r
Describe the proposed business including use, number of employee , nu b of shifts, available parking spaces, number of
vehicles, and any additional information that you can provide: llk6 es5loAlAl 4 F Fl C.e.- 8 L a o Va S.- d
/Z Ve%-r4 to
e vrl to ee s 12 s
"This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or trove 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. 1 also certify that the information provided
is true and accu to the best of my knowledge. I have read the conditions of approval,, andl understand them, and that I will abide by them.
Signature #W IWA1144Printed //'�M z
7 K0
APPROVAL INFORMATION
[k] 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 OMcial 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 711/2011 Page 2 of 3
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Intake to complete the following:
Y/N
Is use in LI, Hl or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
MWE
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
Reviewer to complete the following:
Square footage of Use: �7-35
CVI N
Permitted as: `
Under Section: 2
Supplementary regulations section:
Circle the one that applies Parking formula: n
Is parcel on private well r public ��Orm,
If private well, provide Heal
Zoning review can not begin until we receive approval from Health Required spaces:
Dept. FAX DATE
Circle the one that ap
Is parcel on septi r pablle sewer?
Y /1--)
Will you be putting up a new sign of any kind?
Sign permit.
Permit #
YI
Items to be verified in the field:
If so, obtain proper
Inspector • Date:
Y / Notes:
Wi ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Viola#ions:
Y/l
If so, st:
P s:
Y/T
If so, ist:
Variance:
Y /., ]
Ifs ist:
SP's;
Y //)
If so, 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, Z01v l x i C!C A.vp rt c ® -
[County application name and number]
was provided to 6 tile- a 3 d 7 e w7 LI -C the owner of record of Tax Map
[name(s) of the record owners of the parcel]
Z,D,0ca
and Parcel Number /—!2-0 by delivering a copy of the application in the
manner identified below: Q
Hand delivering a copy of the application to A ! Uel- 'S
Cd e. .� � � L
[Name 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 office for that entity]
on 14
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].
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Signature of Applicant
,%ii/ hlow,*a I
Print Applicant Name
Date
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