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Home My WebLink AboutCLE201500225 Application 2015-11-11Application for Zoning Clearance CLE # °— Qa!g OFFICE USEQNLY PLEASE REVIEW ALL 3 SHEETS Check # Date: . --I Receipt # 1 O staff: 2MIM PARCEL INFORMATION ,/ Tax Map and Parcel: _04 ro 00 /OV.pI Existing Zoning Parcel Owner V6v.:;- E L1 / � //C 14 1 Parcel Address: /2q 94c -- city fYj� State y74- , Zip (include suite or floor) PRIMARY CONTACT Who should we call/write concerning this project? �/r �C� /®r / VSn- Address : god �-,o"J ,>b4 300 City C /rte rt r / 4 State VA Zip Office Phone: 3 —/J�-� Cell �X- # 3+ g�� / ' i �j�h Ile-, V.2 APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business BusinessName/Type: ICe 1 Previous Business on this site L./ Describe the proposed business including use, number of employees, number of iftsrj availabl parking spaces, number of vehicles, and any additional information that you can provide: *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 th wn or have the owner's permission to use the space indicated on this application. I also certify that the information provided is true and acc ate to a best of my knowledge. I have read the conditions of approval, and I underst d them, and that I will abide by them. Signature Printed AP ,MWVAL INFORMAT40N Approved as proposed [ ] Approved with conditions [ ] Denied [ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 9774511, 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 Date Zoning Official Date t 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 11/1/2015 Page 2 of 3 Intake to complete the following: Y `N Is u LI, HI or PDIA zoning? If so, give applicant a Certified Engineer's Report (CER) packet. YWN Will there be food preparation? If so, give applicant a Health Department form. Zoning review cannot egin until we receive approval from Health Dept. DATE d eo 11.5 Circle the one that applies Is parcel on private well ublic water. If private well, provide Heal a ent form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that appI' Z parcel on septic public sewer -,`� Y �N -1111you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Y 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: Permitted as: + Under Section: Supplementary regulations section: Parking formula: Required spaces: YI Item be verified in the field: Inspector : Date: Notes: ViolM,ons: Y/tVi If so, ist: Profs: Y�NJ Ifs ; ist: Var'e: Yl If so, )St: SP's: Y If sol, est: Clearances: SDP's Revised 11/1/2015 Page 3 of 3 Application for Zoning Clearance CIE it _ c) PLEASE REVIEW ALL 3 SHEETS OFFICE USE -ONLY Check # 1-551c) Date: 1 I if / [Receipt# [[ O D Staff: PARCEL INFORMATION Tax Map and Parcel:: (9 019 � A911 I Existing Zoning (2/_ C►a/"1M d're_1g l Parcel Owner: "\16vl.' ��%` IC . Parcel Address: �� 11.5 Ems`-_GityL�7�'r!o O' State_ rN (include suite or floor) --Zip. PRIMARY CONTACT Who should we calltwrite concerning this project? /r x r os-� �� r r�e✓CZ /m p� Address • goo .c�aii i Ax'/ 3d0 gty s/p �S r�I� State Il zip oda I office Phone: $ E�2Ce11 -3 # 3 9 -2y'5-!n ail APPLICANT INFORMATION Check M that apply: Change of awnershi Change of use Change of name New business Business Nametrype; Previous Business on this Describe the proposed business including use, number of employees, number of iftsavailabl parking spaces, number of vehicles, and any additional information that you can provide: 5�c. •t;K8" seri *Thin Clearance will only be valid on the parcel for which it is approved. If you chwWA intensify or move rile use to a new location, a new Zoning Clearance will be required. I hereby certify Th wn or have the owner's permission to use the apace indicated on this application. I also certify that tht information provided is true and ace tete he best of my knowledge, l have read the conditions otapproval, and 1 unde d thein, and that I will abide by thorn. Signature printed.—*'.. ��' APPROVAL iINFORMA N [ ] Approved as proposed [ ] Approved with conditions [ ] Denied j ] Backflow prevention device and/or current test data needed for this site, Contact ACSA, 9774511, x117. [ ] No physical site inspection has been done for this clearance, Therefore, it is not a determination of compliance witis the existing site plan. f 3 This site complies with the site plan as of this date. Notes: Building Ofticlal Date _ i► Zoning Official Date Other Official Date Zz /G615 County of Albemarle Department of Community Development 40I McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126 Revised 1111127015 Page 2 of .m NrW HOME WN57 M"ON R°�Y M.o.s.VA 84151 �1 FG51dinLq ►.- o�luz ►'�T'til n� ion5 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 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 V 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 A 1 Printpplic t ame /l 7y�s. Date