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HomeMy WebLinkAboutCLE201600047 Application 2016-03-18Application for Zoning Clearance CLE #.k& — 0!>0 7 0— OFFICE USE ONLY PLEASE REVIEW ALL 3 SHEETS Cheek # 58.5 Date: 3 / collo Receipt # /b 3 3aCo Staff: PARCEL INFORMATION Tax Map and Parcel: Existing Zonis Parcel Owner: jr CFro Parcel Address; Mice City Cha -1 O ,es1rdicstate . VA Zip armW (include suite or floor) PRIMARY CONTACT Who should we call/write concerning this project? Address: 104 + 2 Douti ' k6 Citi,' . �� AI State VA zi t Office Phone: ( Cell # _SD-LQgQ ,5&60Fax # -3I03 E-mail t L i - APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name A New business Business Name/Type: i r Previous Business on this site Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of vehKies, and any additional information that you can provide:(; -ce jW lma `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 drat the information provided is true and accurate to the best of my knowledge. I have read the conditions of approval, and I understand than, and that 1 will abide by them. Signature ti11 Printed Uo,,2L,vt APPROVAL INFORMATION J] 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- ri r - Zoning Official Date���/a6�� Other Official Date County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 2%-5832 Fax: (434) 9724126 Lv. POO?— l' l R') 61 Intake to complete the following: Y /(V Is use to LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y /(N> Will 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 a wat 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 pahlie'se . Y/N ill you be putting up a new sigh of any kind? If so, obtain proper Sign permit. �P Lj; 102 1OP 4 7 3-4-10 Permit # Y l Will ere be any new construction or renovations? If so, obtain the proper Permit. Permit # Zoning to complete the fellowin : Reviewer to complete the following: Square footage of Use: YIN Permitted as: Under Section: Supplementary regulations section: Parking formula: Required spaces: Y/N Items to be verified in the field: Inspector Date: Notes: Violations: Y/N If so, List: Proffers: YIN If so, List: Variance: Y/N If so, List: SPIE: Y/N If so, List: Clearances: SDP's Revised I111M15 Pave3 of CERTIFICATION THAT NOTICE OF THE APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER This form must awompmv zoning applications (#!orae ©ccwndfon, Zoning (OOnct, Zooming Administrator Determinations or Appeals, Sign Permits, Building Pennfts) f the application is not the owner. I certify that notice of the application, Zon'l nq Ck"X . Son pe-rml ` [Cminty application nfime did number] was provided to 2k the owner of record of Tax Map [name(s) of the record ownerg of the parcel] and Parcel Number LLI �[� 2 -n _ - (�fc 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 vj [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 3_ 1=i Io to the following address: Date [address; written notice mailed to the owner at the ladt 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]. Print Appli&mtN � � II" LP _ Date