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HomeMy WebLinkAboutCLE201600114 Application 2016-05-27Application for Zoning Clearance El OFFICE USE ONLY PLEASE REVIEW ALL 3 SHEETS Check # �` Date: Receipt t# _ j 4 3 Staff: PARCEL INFORMATION Ait� Tart Map and Parcel: 4. 00' 00. O { C fl� Existing Zoning_ Parcel �zS Ge � ti 7 Parcel Address: t{14 ' r1-0 t r . City _� V; { { �[ State t(c� Zip 1 i (include suite or floor) PRIMARY CONTACT Who should we caWwrite concerning this project? Address :- Q L i, _ (nX=46c.-1 k a A - -City �IG,� cwr � ca � State VC �l2y Zip O£frce Phone: (�� Cell # 9t.�-i �1,� F`ax #� -- E-mail , }Q e l 0'Nca tvtac;rtt , . r ArYLLI :ANT INFORMATION Check that business Business Narnerl'ype: S w_ Previous Boone" on this site Of of use Change of name - - Describe the proposed business including use, number otemptoyees, trutaber of shifts, available parking spaces, number of vehicles, and any additional information that you can provide: WThis Clearance will only be valid on the parcel 1 for which it is approved if you change, intwsd(or move the use to a new lomden, a nc►; jng Cieareacr will be required. l hereby certifj+ that I own or have the owner's permission to use the space indicated on this application. I also certify that the infer W1()n provi&d is true and accurate to t of my knowledge. 7 havn read the condieiorts of approval, and { understand the,r►, and that T will abide by them. Signature -. Printed np, [ : APPROVAL INFORMATION — Approved as proposed [ ] Approved with . onditions ( j Denied j ] Sackf]ow prevention device and/or current test data neaded for this site. Contact ACSA, 977-4511, x 117. [ ] No physical Site inspection has been done for this clearance. Tlt_retore, it is not a determination of compliance with the existing site plan. [ i This site complies with the site plan as of this date. Notes: Building Official -...._Date 's L Zoning Official % Dale,, Other Official _ Date County of Albemarle Department or Cnmmunity Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-M2 Fax- (434) 972-4126 Revised 7/WGl 1 Page 2 of 3 RECEIVED MAY i .670 M Intake to complete the following: Y I Is use in i ffl or PDIT' zoning y If so, give applicant a Certifwd Engineer's Report (CER) packet. Yr' Wilticre 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 wellbr public wetter? If private well, provide Health Department farm. Zoning review can not begin until we receive approval from Health Dept FAX DATE Circle the one that ap s" Is parcel on septic I public sewer? YIN Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # YIN Will there be any now construction or renovations? If so, obtain the proper Permit. Permit # Reviewer to complete the following: !iquare footage of Use. k`N Permitted as: r oAA1 Z1 es,` v Unjer Section: : N, ' t �'- Supplementary regulations section; Parking formula: Required spaces: Items to be v�fled�thrfield: 1 � Inspector Notes: Zoning t© complete the following Violations- Pro `'i a: Y/A Y/ If so, ist: If so, List: Yar! �e: Y 1 iri If so, tst: 1 If so, List: r rance.q: Date: Revised I1/112015 Page 3 bf 3 CERTIFICATION THAT NOTICE OF THE APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER This form must awompany aonkg upplicat 0MS (Home 4ccrrpadoi4 Zoning Qearance, Zoning Administrator Deteradnadons or Appeals, Sign Permits, Building Perm) if the application is not the owner. I certify that notice of the application, zlo Yam., n C A e! (Count3Happiication name and number] was provided to r^w►`� �,�.. _ _ the owner of record of Tax Map [name(s) of the record owners cif the parcel] and Parcel Number. Oq6 [3 q- OLD- 90-- o i. 0S)2 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 S- "J " t — to the following address; Date U(' , -Z z eL 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]. 4Signrcomffp--pl�icant ry Fi int Applicant ?lame IS-q- I Date