HomeMy WebLinkAboutCLE201600115 Application 2016-05-27Application for Zoning Clearance _
CLE # ��� ���'j
,l
aMCE USE ONLY
PLEASE REVIEW ALL 3 SHEETS Check # 3 _ Date:
Receipt # 104103- staff:
PARCEL INFORMATION
Tax Map and Parcel: e)7 )00 -()0
Existing Zonin
Parcel Owner:
Parcel Address: d �2 r C:itK:J"� jJ_kJ State Ar
(likelude suite or floor)
PRi __.ARY CONTACT
Who should we eaWwrite concerning this project? L ",Q.�Address: '104 f a:t. Qbtl=l .._ (2J city V, y � rJ � c._.) t— State Zt
_j� Zip "�c{'3
Office Phone: C) Cell #1 4.0-572fa kax # E-mail a nda4p
t: a
APPLICANT INFORMATION
Check aav that
of
Business Nameli'ype:
Previous Business on this site
of use Change of name New business
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. lfyou change, intensify ormove the use to a new location, a new ZuIling
Clearance will be required.
I hereby certify that I own or have the owns permission to use dkc space indicated on this application. 1 also certify that the Wbnnation provides
is true and accurate the best of my knowledge. I have read the ccuditions of approval, and I understand them. and that I will abide
—by them
signature __._....... �! K Printed L_A r) ZT
APPROVAL INF'OItMATION _
Approved as proposed f ] Approved with conditions [ Denied
( ] Backflo►v prevention device and/or current test data needed for this site. Contact ACSA, 9774511, xI I7.
I l 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.
Notts:
Building Offiicial �' -Date _ &�
Zoning offiew tJ, A Date S
OtherOfficial Date
County of Albemarle Department of Community Development
40) McIntire Road Charlottesville, VA 22902 Voice. (434) 296-5"2 Fax: (434) 972-4126
R E C El V EO MAY 16 lDra Revised 711,t201 i Page 2 of 3
F
ntake to complete the folio�ing: Reviewer to complete the following:
iVSquare footage of Use: use �n LI, Hl or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet. 16)t N J
IPermitted as: ..�i,'rf�iQ,•..' � �. �'P/
Will M" re be food preparation? Under Section: «,
If so, give applicant a Hearth Department form, ——AJ
Zoning review can not begin anti I we receive approval from Health Supplementary regulations section:
Dept. FAX DATE
Circle the one that applies - ! Panting formula:
Is parcel on private well or gublic er?
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health Required spaces:
Dept. FAX DATE
Y/
Circle the one that applies Items to be verified in the field:
Is parcel on septic or c yewpr?
YIN
Will you be putting up a new sign of any kind? If so, obtain proper
E Sign permit.
Permit # Inspector,-- Date -
I Y I N Votes:
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the fn#lowing:__ --
rviolations; prot'fers:
Y/tq� N
if.so, L • If so, List:
.............
i'ariancr:
Y/
I Y / >,'�.'�
If so, ist: If so, List:
i
Cleat rances:
Revised 11/1/2015 Pap 3 bf3
CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
This form Hurst accompany zoning applications (Home Occupation, Zang Clearance, Zoning
Aditbdstrutor Determinations or Appeals, Sign Permits, BuUding Permits) if the applkaden is not the
owner.
I certify that notice of the application, ea,�, , G,� ,� ,►-t c �_�
(t;aunty aplAcation name and number]
was provided to .JL „- k pyp the owner of record of Tax I&p
[name(s) of the record Owners of the parcel]
and Parcel Number 0-- 037 Q �� 0 6 by delivering a copy of the application in the
manner identified below:
Hand delivering a copy of the application to
['Warne 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 rexipient,s
title or office for that entity)
on
Date
t/ Mailing a copy of the application to V\,-\,,, _1\.e— 1 rY\,M 0-4—
[Name of the
d owner �jf the record owner is a
if the owner of record is an entity, identify the recipient ro of the record and the recipients title person;
office for that entity)
on 'S" ' 1 0 to the following address:
Date
. V4 _�Ip�
[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],
r
Si nfature of Applicant
Print Applicant Name
I
r-1
c.�