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Home My WebLink AboutCLE201600003 Application 2016-01-11.AppHeadon for Zonin Clearance CLE #_ 201in^ lei_ OFFICE USE QNLV j PLEASE REVIEW ALL 3 SHEETS Check# Date: `7 i U Receipt # _ 027 (01 Staff: f Lan-tZ PARCEL INFORMATION 4 Tax Map and Parcel: Cel Existing Zoning_ Parcel Owner:_ bmi n s 1 dc.-► ssockMe S L? Parcel Address:gIq IVYR i- SuJ.; t= 105 City C'WAD�Le&,&destate A Zip 7ZID7 (inclnc suite or floor) PRIMARY CONTACT Who should we call/write concerning this project? ;nf i colctb Address: r ��`-� IC(1 � t r t 1D (o City Ca. \4 J-1 State Zip 2-290 Office Phone:'lwJ 2..95-� Cell#. _`I3q-i91Asx# o?Qs-CofrFZ E-mail esr ILd' ,fa!xf?Czrii.0-o" APPLICANT INFORMATION Check eny that apply: Change ofown7p� c--jjership -- Change of use Change of name New business Business Nametrype: " 6yuft orQ— S Previous Business on this site _1, nf;a.he ns [ r- -Dti 4: X 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:- PeemDat- ri -9 o4�cz ,., t4 -k 4 - (. . *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 owners permission to use the space indicated an this application• I also certify that the information provided is true and accu to the best of my knowledge. I have react the conditions of approval, and I understand theca, and that I will abide by them. Signature c Printed Wa4' APPROVAL INFORMATION I ] Approved as proposed f ] 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. f ] This site complies with the site plan as of this date. Building Official Zoning Official Other Official Date Date 0 Date County of Albemarle Department of Community Development 441 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5532 Fax: (434) 9724126 Revised 11/1=15 Page 2 of 3 Intake to complete the following: YlN is use in I.J. HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y Will ffiere be food preparation? If so, give applicant a Health Department form. Zoning review can not begin until we receive approval from Health Rept. FAX DATE Circle the one that applies Is parcel on private well or lic water? If private well, provide 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 septic or public server? Y T`r Will you be putting up a new sign of any kind? Sign permit. Permit # If so, obtain proper I Y / N Will ere be any new construction or renovations? If so, obtain the proper Permit. Permit # Toning to complete the following: Reviewer to complete the following: Square footage of Use: `T q q $7, N (� ,fitted as: Under Section: 2� - 2'r Supplementary regulations section: Parking formula: y r Required spaces: (� Y / 1VT Items to be verified in the field; Inspector : Date: Notes: Viol ns: Y /&) If so, List: Prof rs. Y 1 If so, fist: Variance:'s: 6)1N If so, List:9-7 I If so, List; -� Clearances: SDP's "13 Revised Revised I1/1f2QI5 Page 3 bf 3 CERTIFICATION THAT NOTICE OF THE APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER This form must aeeompW zoning applications (Home OwupaiUn, Zoning Clearance, Zoning Admirdstrator Determinations or Appeals, Sqn Permits, Building Permit) if Ike application rs Trot 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 appy 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 recoil 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 fol lowing address: [address; written notice mailed to the owner at the last known address of the owner as shorn on the current real estate tax assessment books or current real estate tax assessment records satisfies this requirement]. Signature of Applicant 2"t rx.4- "IA - Print Applicant Name Date ��o 0 d O t� rr t-� r y H BENCO PLAN NO. W �o DvtL BY OF � ` Z RASE 0 SCALE E _-_ -__- - _-- --, i i DENTAL TITLE, T71Tf-ITTI Arf %ATT Tc'^«r%MLr • iso 3 Asa Q SUPPLY C O . 11 BEAR CREEK BLVD, WILKES-BARRE, PA, 18702-1108 (717) 825--7781 BY BATE REVISIONS ESTABLISHED IH 1930 A FULL SERVICE SUPPLIER WITHOUT SERVICE THERE ARE Na BARGAINS' ;o i I DENTAL TITLE, T71Tf-ITTI Arf %ATT Tc'^«r%MLr • iso 3 Asa Q SUPPLY C O . 11 BEAR CREEK BLVD, WILKES-BARRE, PA, 18702-1108 (717) 825--7781 BY BATE REVISIONS ESTABLISHED IH 1930 A FULL SERVICE SUPPLIER WITHOUT SERVICE THERE ARE Na BARGAINS' .imp _ analown sebum -MESS a■amn - �mmum ONE MEN .. ■i■■■m■uimam ■ommu■mumume , NOON BEENE ME■Er11 ■■NSON I d! i t i 0 owl' IL a • as v