HomeMy WebLinkAboutCLE201500258 Application 2016-01-11Application for Zoning Clearance
CLE #
OFFICE UAE ONLY
PLEASE REVIEW ALL 3 SHEETS Check # "taLl "toDate: 7 I }
Receipt # _.1 6 a H $ 3- Staff:
PARCEL INFORMATION _ 6�
Tax Map and Parcel: Existing Zoning�.
Parcel Owner:— Aloyc 4i -e -j L -L(
rF—aLx
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Parcel Address:- V 17f C(Pr7 c [�1VCity Iii1Gd Id4511? 1& State l/ 1. ,._ zip �Xo
(include suite or floor)
PRIMARY CONTACT
Who shouldwecall/write concerning project9 r t�)�
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Address : + od ccf r dP �F j 1V I c # City ha t �oqI& �1�11 � State �/ I� Zip- 90
Office Phone: d3-Yj ?,0 % 3lm Cell# VN-)03--26)Fax# E-mail:6e- (;X G+Xe[�!jci4ob.0
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: r IU ki
Previous Business on this site ,qa" s' l—on
Describe the proposed business including use, number of employees, nu ber of shifts, available 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 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 bbelt of my knowledge. I have read the conditions of approval, and I undde�erstandd them, and that I will abide by them.
Signature Printed_ 4.Y (7G(``/f e2
APPROVAL INFORMATION
kC] Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 9774511, xl 17.
[ ] No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
site plan.
[ j This site complies with the site plan as of this date.
Notes:
Building Official Date I
Zoning Official Date
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
#1
Intake to complete the following:
Is use in LI, M or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /C PereWill 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
Circle the one that applies
Is parcel on private well o ublic water.
If private well, provide Heal epart hent form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE- _ _ _ _
Circle the one that ap
Is parcel on septic or ublic sewer?
Y)1 N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y / (V.
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: LO (() ^
Y/N
Permitted as: LIZ �`v�✓
Under Section: ` 2
Supplementary regulations section:
Parking formula:
Required spaces:
Y /C1
Items to be verified in the field:
Inspector
Notes:
Date:
Violations:
Y1Yl
If so, st:
Pro rs:
A.
If so, ist:
Variance:
6/N
If so, List:
SP's:
Y/N
If so, List:
Clearances:
SDP's
Revised 11/1/2015 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 or Appeals, Skn Permits, Building Permits) if the application is not the
owner.
1 certify that notice of the application,
was provided to
[County application name and number]
[name(s) of the record owners of the parcel]
the owner of record of Tax Map
and Parcel Number by delivering a copy of the application in 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 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].
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Sijidature ofApplicant
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Print Applicant Name
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