HomeMy WebLinkAboutCLE201600113 Application 2016-05-27Application for Zoning Clearance
CLE # of-jh�
OFFICE USE ONLV
PLEASE REVIEW ALL 3 SHEETS Check # $ ZZ 3 Date:
liecelpt # �F O 3 i Staff:
PARCEL INFORMATION
Tax Map and Parcel: • u i - u a ` t>z L.aj Existing Zoning
Parcel Owner: S5 CL L.L C_ - n-. L, ( g 4 ( _rl r__fw .+ .& Cara It,
Parcel Address:p
(include suite or floor)
PRIMARY CONTACT Who should we calUwrite concerning this project? LA ,,t-{-}-
Address : 61 L.L City State
Vi$ -
Office Phone:(_) Leff#4Lcs-0u._Fax E-mail�s
j!1 [ ftili- t is,r.
APPLICANT INFORMATION
Check any that apglyr. Change of ownership Change of use Change of name New business
Business NameiType: �f7A c.. far f i e 5
Previous Business an this site
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicles, and any additional 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 anew loeatiM anew Zoning
Clearance will be required.
I hereby certify that I own or have the owner's permission to use tic space indicated on this application. I also certify that the information provided
is: We and accurate best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signattm Printed (-n -Q-_
APPROVAL INFORMATION
[ ) Appmved as proposed ( ] Approved with conditions [ ] Denied
[ ) Bwkflvw prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, x117.
[ ] No physical sits inspection has been dote 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
Zoning fir:DoteL,
Other Officiad
— Date
County of Albemarle Uepartmcut of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296.5832 Pax. (434) 972-41,26
Revised 7/0011 Page 2 of 3
RECEIVED MAY 1$
Circle the one that applies
Is parcel on septic or �n�lic sewe,'!
]
YIN
Will you be putdng up a new sign of any kind? If so, obtain pro
Sign permit
Permit #
YIN
Will there be any now construction or renovations?
If so, obtain the proper Permit.
Permit #
Joiala<- to complete the rohowing:
YIN
Is use in LI, HIor PDIP coning? 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 or p6lic water?
If private well, provide Heap padment form.
Zoning review can not begin until we receive approval from Health
D4--t. FAX DATE
iY1
Items to be verified in the field-
j --
I Inspector • Date:
]Votes:
I
Reviewer to complete the following:
i
Square footage of Use:
/N J
i� Permitted as:
! Under Section a '"Q,
Supplementary regulations section:
Parking formula:
Required spaces.
Zoning,,i� complete the folio -wing:
Via ,vn�: PraIT.
Yl YIN .
If.so, ist: i If so, s1.
S's:
YI I
If so; List: ; so, List:
Clearance;.:
Revised 11/1/2015 Page 3 of 3
CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
Ties form Masi accompany zoning appheaiions (Home Occupawn, Zoning Ckarance, Zoning
AdmVW&aior Determinations or Appeals, Sign Permits, Building Permits) if the appherxtion is not the -
owner.
I certify that notice of the application, 21o,r.,, r` C— k eE � � w_
[County ap ation name and number]
was provided to T-Ly - S 50 l.l_ L the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number 6(n 1 ;; o - 0 3. 0o - 0 J" J _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 VA. > % �) Gn� V%
[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 `# 12 its the fallowing address:
Date
a�J . 33 c- kC *v-,,c.r -D,. tj1Q,y to ^ "c4y,l I C VLF 2-Z o i
[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 of Applicant
�r--� C . S t.--z r[rt
Print Applicant Name
5" +t.6
Date
I