HomeMy WebLinkAboutCLE201600119 Application 2016-05-27Application for Zoning Clearance
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE QQNLY
Check # cad 9 ` Date: b
Receipt # Staff-
PARCEL INFORMATION
Tax Map and Parcel: �12 0 Existing Zoning C fl _
Parcel Owner: uUA Rioff. 4.Sf44 Fuun dQh 0O
Parcel Address: HOO W arr c, l ! 6ye— City - I! State VA Zip ZZyI 1
(include suite or floor)
PRIMARY CONTACT y' nI ' J� , r
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Who should we call/write concerning this project? _u 1
Address • lib b U V b lnrefl tJ Vl ✓e— City C20 1 It State Zip Z Z 1 I
Office Phone: 144'" 3Cell # 10 J+Q9Sz Fax #7 ' N35 E-mail L�DMOey f r 1y, 4rw JAA
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APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: L&A bIK VI H?r- N 2 0 a l l j [V }oL f atf (A(, L - 4 W t (A a
Previous Business on this site-ffn L4.0- 4kElL PrLI
Describe the proposed business including use, number of employees, number of shifts, available parking spaces number of
vehicles, and any additional information at you can provide: 00 d Lf g_'r
L it
*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 own or have the own 's permission to use the space indicated on this application. I also certify that the information provided
is true and accura t the best of M91ILnow dge. I have read the conditions of approval, and�
I understand them,, and that I will abide by them,
1V t f 1
Signature Printed_ L IA u tpo f [y teU (jL,
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 ( ( 6
Zoning Official Date S La
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 11/02/2015 Page 2 of 3
Intake to complete the following:
Y/N)
Is use to LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y 1
Wil 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 ublic water
If private well, provide Heal Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on epti or public sewer?
Y I
Will u be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y
Will ere 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: —j; DUc1
& / N
Permitted as: 4CC.,/11t—._/_ femo e.l
Under Section:
23.2
Supplementary regulations section: nn 1 r
�aCM, SbY�c l ,
1
Parking formula:
Required spaces:
Y/N
Items to be verified in the field:
Inspector • Date:
Notes:
Violations:
Y/(&)
If so, —List:
roffers:
N/N
If so, List:
Varia e:
Y / l)
If so, Ist:
SP's:
Y / N
If so, List:
Clearances:
SDP's
Revised 11/1/2015 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, Building Permits) if the application is not the
owner.
I certify that notice of the application, 7i() p l V�q G c C A 1[AV C Ec
[County application name and number]
was provided to L� UU it lA N'1�'fi ►`i the owner of record of Tax Map
[name(s) off the record owners of the parcel]
and Parcel Number _ �� i `ISM by delivering a copy of the application in the
manner identified below:
Q 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
EzMailing a copy of the application to I n L l/1 V A- T) Lk N P A-J d i Y
[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- 91 I 11 � 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].
L� A 1- 'I.IVJ
Si ture of Applicant 0
1/" Rq N IA"P) P�.f
Print Applicant Name
Ll �1 S
Date
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