HomeMy WebLinkAboutCLE201600131 Application 2016-05-31Application for Zoning Clearance
CLE # m r110 AJ_'phllal -F&,.`416. l 1 ewr f eng a
USE ONLY
PLEASE REVIEW ALL 3 SHEETS Check #
Receipt #
Staff:
PARCEL INFORMATION
Tax Map and Parcel: I w Existing Zoning C--
Parcel Owner: C
Parcel Address:-00 �Gd Mw OrA Sit City CkwJ o vi f U.. State ✓d Zip 1&M&1o)
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? &V_C) rL0Ht,- vb- - ELi16.-J 017
Address : « C %1 )lt City t State Ve+- Zip ZIR
1 4e[� _l Irr .
Office Phone: (� �,is0 • S �%Z Cell #.�� 7io-i+m0 Fax # E-mail ��LLMc+hj/t IOWA
i APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name 9K New business
Business Name/Type: r •[,_
Previous Business on this
V,
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, nuirber of
vehicles, arkd any additional information that you can provide: _ �rr'1e- -�� � ddcLt c-Fl aft enoA Aiwa
"This Clearance will only be
Clearance will be required.
is approved."If you change, intensify or move the use to a new location, a new Zoning
I hereby certify that I own or have the owner's permission to use the space indicated on this application. I also certify that the information provided
is true and accurate to the best of my I ham read the conditions of approval, and.I understand them, and that I will abide by them.
Signature
Printed &9ndcyy, X7C2&,,, Alp
APPROVAL J!9PRMATION
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 3c
Zoning Official Date -5 -31A!
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 l l/l/2015 Page 2 of 3
Intake to complete the following:
Y/NO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y
Will 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 o ublic water9
If private well, provide Hea apartment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that a lies
Is parcel on septic o public sewer?
Y
WiPyou
be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y
Will Ptere 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:
0/N
Permitted as:
Under Section: s-Gs�-� !
Supplementary regulations section:
Parking formula:
J-0
Required spaces:
YI
Items o be verified in the field. -
Inspector : Date:
Notes:
Violations:
Yl
If s&, ist:
Pro
Y/
Ifs , List:
Variant
Y/
If so, List:
SP's•
Y/1
If so, t:
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 theapplication is not the
owner.
I certify that notice of the application, Zmnn C. &ar-1UAT'
[County application name and number]
was provided to 'P6M1WP, L1� _ the owner of record of Tax Map
[name(s) of the record owners of the parcel]
agd Parcel Number 6t M j --!3% 3 D by delivering a copy of the application in the
manner identified below:
Hand delivering a copy of the application to ,-z&w Rgj a Mew W4 V WM , t 4G
[Name of the cord owner if the record ow&r A 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]
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 satisfirs
this requirement]. +
Sigriature of Applicant
PrIA Applicant Name
Date
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1 M -- I H - �A 4-3.D