HomeMy WebLinkAboutCLE201500217 Application 2015-11-19�7
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Apphication for Zoning Clearance
CLEC Zof13
O"ICE USE ONLY
PLEASE REVIEW ALL. 3 SHEETS Check # 01 Date: 2 J
Receipt # 10
I..Staff.
PARCEL INFORMATION r��
Tax Map and Parcel: ^ 421. ,.T _ Faiwng zouin
Parcel Owner* n' S e
�t
Parcel Address-. ' _ City "-' State Zvi'_' _ 2 i0
(include suite or floor)
PRIMARY CONTACT
Who should we calUR7ite concerning this project? _ 7D, -,X�ANJ
i'yv• �_
Address.Zit City state ` Zips' i
Office Phone: (_� Ce[l # e� FRI # E-mail
APPLICANT INFORMATION
Check any that apply: ___ _-_ Change of ownership Change of use Change of name New business
Business NamejType: �" t • !E' t'.. "4 �' "' � — � ��
Previous Business on this site
Describe the proposed business including one, number of employees, nXimber of sh1%, available parkin spaces, number of {
vehicles, and any additional information that you can provide: '1�1P&A&t(* d& '�, CoA=
''Phis Clearance will only be valid on the pure) for which it is approved If you chauge, iataaaify or nave the use to anew location, anew ZcRi
Clearance will he wquiM.
I hereby certify that I own or have the er"s ion to use the space uidimted ou this epplieatiou 1 alio cartify that the mfo =tion provided
is true and wouraw to the tient o y Inn gc. have read the s of approval, and I understand ilian, and that 1 vn a by them.
Signature Primed ! )"ti'b l
APPROVAL INFORMATION --
>cj Approved as proposed [ ] Approved with conditions [ ] Denied
( ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, x117.
[ j No physical site inspection has been done for this clearance. Therefore, it is not a detertttinallon of compliance with the existing
Sitc plan.
[ ]'Phis site complies with the site plan as of this .date.
Builtiing Ofilcial Date . _-��_a�` �_c 1 _.
Zoning Official � _ � ! Date
Other Official , " Hate
County of Albemarle Department of Community ]:Development
441 McIntire Load Charlottovilic, YA 7,Z902 Voice; (434) 296-51132 hint• (434) 9724126
Remed 7/112011 Page 2 of 3
Intake to complete the foll.o wing:
Y 1(N J
Is us m 11,1.8 or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Q�'[ N
Il there be food preparation?
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from Health
Dcpt FAX DATE—, .
Circle the out that applies
Is parcel on pri to well orCbl�lwatp.tIf private well, provide Heaform
Zoning review can not begin until we recetve approval From Health
DepY. FAX DATE
Circle the on that ap
ttrcel on septic o public sew
Y N
VC you be putting up a new sign of stay kind? If so, obtain proper
Sign permit.
PCru It #
Y/N
Will there be any now construction or renovations?
If so, obtain the proper Permit.
Permit # ^ 2 U /�— / 3 G -7 4<-,
Zoning to complete the following:
viola us:
�Y
If s1e, isk
riance:
/N
if
so,
Listr
AP- %
Reviewer to complete the following:
Square footage of Use:
xr /
'err%nittcd ns:
Under Section: -?Z,,, - _�' �•�
Supplemcntaryregulattons section:
I Parking foratula. NM
Required spaces:
9 f .
Itca►s o e verified in the field:
bspettot : Date -
!rotes.
N
Oro
tZCF, List:
Yh't: if
Revised 7/]/2011 Page 3 of
CER'T'IFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
This form must accompany zoning applications (Home Occupation, ming Clearance, Zoning
Administrator Determinations or Appeals, Sign Permits, Building Permits) if #16 application is not the
owner,
L certify that notice of the application,
[County application name and number]
was provided to the owner of record of Tax Map
[name(s) of the record owners of the parcel)
and Parcel Nwnbet by delivering a copy of the application rn the
manner identified below -
Hand delivering a copy of the application to
[Name of the record owner if the record owner is a
person; if the owner ofrecord a an entity, identify the recipient of the record and the recipients
title or office for that entity]
on
D rc
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 to the following address -
[address; written noU" marled 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
Us requircment).
Date