HomeMy WebLinkAboutCLE201500257 Application 2015-12-17Application for Zoning Clearance
CLE#
OFFICE U E ONLY
PLEASE REVIEW ALL 3 SHEETS Check # �" t I Date: Wl 15
Receipt # `'t$6 Staff:
PARCEL INFORMATION ?
Tax Map and Parcel: S 6 F l Q- Existing Zoning
Parcel Owner: 9nw1,%er A5SaekA�S
Parcel Address: 325 F?4f L94 LAwe, Sk►e 11A City C6r1oj-_j55vj1e State A Zip 11903
(include suite or floor)
PRIMARY CONTACT 1
Who should we call/write concerning this project? AIlakrot pee LaK 13 A
Address: 3Lfo G r,yro City (C),le-t State A Zip22132
Office Phone: l t i l —3(;-7 Cell # 434-401-3637Fax# hl-, E-mail In � t�I►,cf�o4�e „k.[ ,rGrr�j
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: [k2 R�4e f a 1y Fra�h' �Lt1 prt f`. litre
Previous Business on this siteAil'
KAF CkAiCA.f L�� �-ioK�l SrCl�3CJLs Ckv►lco-P
fs�yc,"i7oatj setvtCA S
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicles, and any additional information that you can provide: L,$e _ rtvw0ta. .tis it—tatA g 066C.&
urw � 2 rdkwL� r c r - 1 c4a► �► a=16A gpowz 2a — v
kNa _ 2 krs n., 1- ea, l,-ek�c a af- ek 6 e 02 tcieg
*This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move the use to anew location, a new Zonift
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. II have read the conditions of approval, and I understand them, and that I will abide by them.
Signature &w 11t,lmk-iN Printed AAAkrol lAe La!t :J� lir►
APPROVAL INFORMATION
jn 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 Official Date I R 1 IS
Zoning Official Date /2%15
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/l/2015 Page 2 of 3
D
Intake to complete the following:
Y l ID
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Reviewer to complete the following:
Square footage of Use: 2 5D
Engineer's Report (CER) packet. / N
Y / ermitted as: Ai j,' dM-JU11
Will there 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
Circle the one that applies
Is parcel on private well o ublic ater?
If private well, provide H panment form.
Zoning review can not begin until we receive approval from Health
Dept, FAX DATE
Circle the one that applies
Is parcel on septic or pu �.
YIN
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Parking formula:
Required spaces:
YI jV
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
YIN
If so, List:
Proffers:
YIN
If so, List:
Variance:
Y/N
If so, List:
SP's:
Y/N
If so, List:
Clearances:
SDP's
Revised 11/1/2415 Page 3 bf 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 orAppeals, 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:
the owner of record of Tax Map
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]
on
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].
Signature of Applicant
A-L4rC1 A4e,Lx,L,q�L"
Print Applicant Name
U,� o'717o157
Date
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