HomeMy WebLinkAboutCLE201600078 Application 2016-04-09Application for Zonin Clearance001
' CLE # —�
OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS Check # Date:
Receipt # Staff -a &-�'A�
PARCEL INFORM TION
A160e
Tax Map and Parcel.-- _ _ Q "L� - _ _ Existing Zonin i
Parcel Owner: i yQ To L" r
Parcel Address: ) L 9a�maY DCity C qY1t#,eSV;1h State V Zip a2gol
(include suite or floor)
PRIMARY CONTACT
Who should we `call/write concerning this project?
Address: �C�� ! ar is Ln City F,5rmrlf State V Zip 4g37
Office Phone: (0f) [b & s (e527 Cell # Fax # E-mail t Il (d.
a
APPLICANT INFORMATION
Check any that apply: Change of ownershipi
Change of use Change of name New business
Business Name/Type: 9 161 i I L t C R�
Previous Business on this site Ja lm
Describe the proposed business including use, number of employees, number of shifts, available Parking spaces, number of
vehi les, and an additional information that you can provide: 5,heaYzY k)O%A+c 4iA 0 1 Y'Lmlo t:I.e[J .3Shif-ff
l`f" i7fXi i�9 5 CAS 3 VehiCk5 ---- ---
*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
CIearance 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 ac to t best of laiowI dge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed D 1LArur'
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, 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 _ _ _ r �-� =--� :_ 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 /1
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
M
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 or public 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 sewer!
N/
Wi
Wil you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
er 't #
Y N
Wi ther be any new construction or renovations?
If so, o tain the proper Permit.
Permit #
Zoning to complete the followinu:
Reviewer to complete the following:
Square footage of Use: �f f
P rmitted as:
Under Section: y y
Supplementary regulations section:
Parking formula:
r�n') --
Required spaces:
YI
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
Y / 10
If so, List:
Prof s:
Y / tv
If so, List:
Variance:
Y /
If so, ist.
SP's:
&/ N
If so, List:
Clearances:
SDP's
Revised I1/l/2015 Page 3 of 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, ButldingPermits) if the application is not the
owner.
I certify that notice of the application,
[County application name and number]
was provided to the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number by delivering a copy of the application in the
manner identified below:
Hand delivering a copy of the application to Q L
[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_ q / 9 /),0(4
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 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].
Signatu/r'e of A i }
e 6� L (J-yY�
Print AppIic Name
4/11��1
Date
1st Floor
0` 8' 12'
1:75
Plan 1
PIPMI
89tillva@gmail.com
2015-04-30
518 sq ft
Floor
4 Rooms
I Office
0 Conf. room