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HomeMy WebLinkAboutCLE201600106 Application 2016-05-04Application for Zoning Clearance CLE It 401 DIP- • w N OFFICE USE ONLY PLEASE REVIEW ALL 3 SHEETS Check # 'emo Date: 14 ow Receipt# 10424D Staff: PARCEL INFORMATION Tax Map and Parcel: �C70Ca D d C>© �1 D Existing ZoningC_ Parcel Owner: Parcel Address: 3.�Vc�L�cac, city( �c crsVt:l�, State ._� Zip'LnOo (include suite or flodW PRIMARY CONTACT Who should we call/write con ernin this ro'ect? C—OLN'Al iypS Address: City C—ySQr[lS�tCtSdfl��State Ir Pr zip ?—n 06 q35f Office Phone: �3 `� ' + Cell # Fax # jk,93 E-mail jY�ts.�7C'�c,m Van aLy APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Changeof name New business Business Name/Type: L(Jf 11�(.1f'f i 10f¢'%ez 5#04df Previous Business on this site Y Cw. Gt3� 4VT Describe the proposed business including use, number of employees, numb of shifts, available parkin �p ces, b o vehicles and any additional infor�ratign atyo can provide: V 1t oLd *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 permissi to use the space indicated on this application. I also certify that the information provided is trueeand accurate bes o J—,wled I v ad�the conditions of approval, and I understand them, and at 1 will abide by them. Signa � Printed ,",visE B.(r' , aw-tm-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 OfficialC:zDate S I (Cv Zoning Official _ w 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 Intake to complete the following: Y/Q Is use in LI, HI or PDIP zoning? Engineer's Report (CER) packet. If so, give applicant a Certified Yl Will Wre 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 r? If private well, provide Healt epartment form. Zoning review can not begin until we receive approval from Health Dept, FAX DATE Circle the one that appl' '- Is parcel on septic or ublic se YIN Will you be putting up anew sign of any kind? Sign permit. Permit # If so, obtain proper j YIN Will there be any new construction or renovations? If so, oil per_ t ,n Permit # Zonine to complete the following: Reviewer to complete the following: Square footage of Use: ;L 2 G'Z) (,SHIN Permitted as: Under Section: �� •2 Supplementary regulations section: Parking formula: Required spaces: /N Items to be verified in the field: Inspector : Date: Notes: Viola Qns: Y/Z If so, List: Proffers: Y/(9 If so, List: Vari ce: Y/ If so, List: SP's-.1 Y/,4V If so, List: Clearances: SDP's Q 2JOA — 93 Revised 11/1/2015 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. I certify that notice of the application, [County application name and number] was provided to :J__ `/ J% the owner of record of Tax Map [name(s) otihe record owners of the parcel] and Parcel Number cG&X�po 4'10 0 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 [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]. Print Applicant Name Date ; F ,,ll1Fmli,Nbzot