HomeMy WebLinkAboutCLE201600080 Application 2016-04-26L,
Application for Zoning Clearance
CLE # _O 1 (P — 8 b 0
OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS Check # C, A& W Date: isI
Receipt # G 39 {i Staff:
PARCEL INFO 'MATZO
Tax Map and Para: _ _ L 1 W — t 2 -I D 02- Existing Zoning Q l ak)ujk'�
Parcel Owner: ( ufle, A s
Parcel Address:_6 .7 3 l3r_-kn•.eP.- C, r •_ City C K fir, , l Mate VA
(in . elude suite or floor) ff
__ Jcvytoo
PRIMARY C_ ONTAC"I'
Who should we call/write concerning this project?
Address: 607 -sca „j [ 1 c... r-- A;c City 4rS+JeState u A- _ Zip ZL 6
Office Phone: (03 Y (.3 Z '56 1 (Cell # Lj3C1' Fax # E-mail 01 ram_ :i va cw &—c, w : r,
APPLICANT INFORMATION cow
Check any that apply: Change of ownership Change of use Change of name New business
Pr^'•iwo; liucires or this sits rJ &CI k5 'f' C---".A." V&I �3
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicles, and any additional information that you c,,�r�provide: L.
*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 that the information provided
is true and accurate to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
`;ignatul r / Printed
APPRO AL 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 Date 4
Zoning Official Date
TT�..
Other Official Ci Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
Revised 1 I/l/20I5 Page 2 of 3
'11�M
Intake to complete the following:
Y /l
Is use n LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y Q)
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 r �'Water?
If private well, provide alent form.
Zoning review can not begceive approval from Health
Dept. FAX DATE _
Circle the one that applies
Is parcel on septic or pu lie 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 followine:
Reviewer to complete the following:
Square footage of Use: Z-01-
Prmitted as:
Under Section: ���,`Z •)
Supplementary regulations section:
Parking formula:/
Required spaces:/
YIN
Items to be verified in the field:
Inspector: Date:
Notes:
Vial ions:
If /
If so —, List:
Proffers:
If lj
Ifs ist:
Varie:
Y/O
If so, List:
SP's:
Y/
If so, Ist:
Clearances:
SDP's
Revised 11/1/2415 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, Building Permits) if the application is not 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:
Hand delivering a copy of the application to
the owner of record of Tax Map
by delivering a copy of the application in 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
V Mailin a co of the application to n
g PY PP L�..✓rc ", ,ems__ .,
[Name -of -the record owner if the-rccord 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 YZ'-j 12 6 % to the following address:
DateIF
[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].
&7
gnature of Applicant
C arc c � _
Print Applicant Name
Date