HomeMy WebLinkAboutCLE201600027 Application 2016-02-16Application for Zoning Clearance
CLE #
OFFICE USE QNLY
PLEASE REVIEW ALL 3 SHEETS Check # _ 1216 Date:
Receipt # /G 313/ Staff:
PARCEL INFORMAT}O
Tax Map and Parcel: CG 3�_ Existing Zoning
Parcel Owner: G i G • Lie e yt L ,
Parcel Address: P ,P -523,7 City J g t�� lk§tnte Zip X
n,n lude.pgj or flo ) - , � „1 , h�,r CSrf Le,
PRIMARY CONTACT
Who should w�e�call/write concerning this project? � a r,.. 1
Address :_, Y t � City S L'u I'll— State
-.— - - —
Office Phone: C--) Cell
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Namef4pe: p o or y Q C �<A!-&'1)
Previous Business on this site
Describe the proposed business including use, number of employees, number of shifts, available par ki�p spaces, number of
vehicles, and any additional information that you can provide: { 6 . Ck„j.•
5 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 ave the owner's permission to use the space indicated on this application. I also certify that the information provided
is true and accurate. t st of my knowledge. I h read the conditions of approval, and I understand them, and that I will abide by them.
Signature _ ,! Printed J o m cm s
APPROVAL INFORMATION
Approved as proposed [ ] Approved with conditions [ ] Denied
] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, xl I7.
[ ] 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 5A Date
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
Intake to complete the following:
Y /�i
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y l(I J!
Wil ere 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 or ublic w ?
If piivate well, provide Heal ent form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE _
Circle the one that appli
Is parcel on septic or ile sew
YIN
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
YIN
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: f 2,0 �)
PIN
ermitted as: tip
Under Section: �• p
Supplementary regulations section:
Parking formula:
Required spaces:
A)
YI a
Items to be verified in the field:
Inspector Date:
Notes:
Violations:
Yl
If so"'fist:
Proff
YIF:
If so, List:
Variance:
Yl�
If so, ist:
SP's•
Yl
If so, ist:
Clearances:
SDP's
Revised l 1/l/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, Sign Permits, Building Permits) if the application is not the
owner.
1 certify that notice of the application,
[County application name and number]
was provided to 6c, ud, Vie f6&4 _ the owner of record of Tax Map
fname(s) of the record owners of the parcel]
and Parcel Number by delivering a copy of the application in
manner identified below:
+� Hand delivering a copy of the application to
the
[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 j
Print Applicant Name
t