HomeMy WebLinkAboutCLE201500270 Application 2016-02-04Application for Zoniq Clearance
CLE #_��5 2
PLEASE REVIEW ALL 3 SHEETS
OFFICF USE ONLY
Check # 01 Date: 1 Z 3aI
Receipt # r CZ tci 7 a stag: Ail
PARCEL INFORMATION
Tax Map and Parcel: 1 Existing Zonis e_z>rn;
Parcel Owner" KtQ We-&Vti lei t
Parcel Address.,S 0 rA . ..J k3(P_ -_ity CrT urs � ,/ 1 e� State V A' zip zXO I
(include suite or to r)
PRIMARY CONTACT
Who abould we call/write concerning this project?
Address: W to 7A City (1 +t _I c]�-Ile state _ _ �` Al _ zip -2-7-1W
Office Phone: �rU ut - Q q C # -Z S FIX # &mail �i1r g La EL "_VVnCR ,
APPLICANT INFORMATION
Cheek anv that enniv+ Fri.-- ..f..a... r.r.:.. nL. ..e
i
Business Namef ype: o - :,.
Previous Business on this site I '5clq- �-SS per.
Describe the proposed business including use, number of employees, number
vehicles, and any additional linfor�mation that you can provide_
"This Clearance will only be
Clearance will be required.
I hereby certify thA own or
is true and accuift to the bei
Signature
on the parcel for which it is apirovi;d. If you
available parking spaces, number of
.i -6_-i_➢ S- _ 1�. _,r
or move the use to a new location, a new
the pwnces permission to use the space indicated on this application, I also certify that the information provided
ay knowledge. I have read the conditions of approval, and I understand them, and that I will abide by thee►.
Printed L_u_ lrl
AO AL INFORMATION
[ APProas propos [ 7 Approved with conditions [ ] Denied
[ ] BaciciloWlprevention device and/or current test data needed for this site. Contact ACSA, 977-4511, xi 17.
t ] 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 Officialpate
Zoning Official 14 ye4A Date
r - I I __q
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 I UUf2015 Page 2 of 3
Intake to complete the following:
Y N
Is use m LI, HI or PDIP zoning? If so, give applicant a Certified
$ngrReport (CFA) packet.
Y
Will there 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 public water?
If private well, provide H form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that ap
is parcel on septic public sews
Y eNN
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y l}
Wit be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zanina to eornnlete the follawinLF_
Reviewer to complete the following:
rzDSquare footage of Use: b -
Permitted as. L�
Under Section: i I
Supplementary regulations section:
Parking formula: I
Required spaces: IR
Y l lh
ltenWto. be verified in the field:
Inspector
Notes.
Viola s:
Y
If slst:
Pro
Y N
If
Varice:
YIN
If rst
SP's -
Y
Ifso, st
Clearances:
SDP's
Revised 1111/2015 Page 3 bf 3
CERTIFICATION THAT NOTICE OF Tiff
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER,
nk form must aacmMwrp zoning applications (Ham 0awaox, Zoning clemmer, Zoning
Administrator DawmfnMens orAppeals, Sign Permfis, Building Permttr) f lite appNeXam is not the
owner.
I certify that notice of the application, _ 7— 0Y 1 Yl LQ.e A-rck n cam._
[County appp ication name and number]
was provided to ROVNat-.. ivC. 4ee1?a/-V,-,a6 _ the owner of record of Tax Map
[name(s) of the retard owners of the parcel]
and Parcel Number. Otte l X i " 00 - - Oi abO by delivering a copy of the application in the
manner identified below; j
VneHand daliveft a copy of the application to 46 tY i S t f�
ame ofthe record owner ifthe 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 I 30 -V5
DWe
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:
Date'
[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].
of Applicant
Applicant Name
zjnle,
Date
rm
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