HomeMy WebLinkAboutCLE201600107 Application 2016-05-04Application for Zoning Clearance
CLE # _ 1P _:L Ledlym-cphergm
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OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS Check # 1111
Receipt # 1bC1,aYJQ Staff.
PARCEL INFORMATION �- � �Q ��--� � ,.
Tax Map and Parcel: +� f Existing Zonin ,,�u '
Parcel Owner: IV UA&iws-e b-e-1
Parcel Address;—G?1! _ C EMSt -1?4t, GA_ City r ha&_*M&State l / A Zip
(include suite or floor)
PRIMARY CONTACT
Who should �wje call/write concerning this project?? Lieslip—
Address :_ 0 �� Jlo &-st Cou-r'i City G�[�/ dti2State r Zip
Office Phone: l 3 lq 63— Cell # Fax # E-mail
42
APPLICANT INFORMATION
Check any that apply: (Change of ownership Change of use Change oof^name /1 New business
Business Name/Type: b ; f S d a nes S t�f
Previous Business on this site
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicles, and any ad itional information that you can provide:`
*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 coonddiit�iorls of approval, and I understand them, and that I will abide by them.
LJYJ
Signature Printed_ �t � /41 �c+ €l' �a d l�e.�, , L.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, 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 1 3 1 t 6
Zoning Official >A 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:
YIN
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
YIN
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 o ublic wate ?
If private well, provide H Dep ent form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applfb
Is parcel on septic or :se;r?
YIN
Will you be putting up a new sign of any kind?
Sign permit.
Permit #
If so, obtain proper j
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:
OIN
Permitted as: -k r
Under Section: FS. A
Supplementary regulations section:
Parking formula:
s
Required spaces:
YI /
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:troffers:
Y/O
If so, List:
IN
If so, List:
T~ o3— II
Varin ce:
Y I
If so, tst:
SP's.
If
If so, Est:
Clearances:
SDP's
0-7 7�
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Revised 11/1/2015 Page 3 bf 3
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RECEIVED
GOMMUNITY
DEVELOPMENT
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, L`e w t S ' y 1- kb
[County application name and number]
was provided to
[name(s) of the record owners of the parcel]
and Parcel Number
manner identified below:
Z— Hand delivering a copy of the application to
the owner of record of Tax Map
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
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 ofApplicant
>�
be-1 [ice AC--Pk-e-tT &n
Print Applicant Name
0
Date