HomeMy WebLinkAboutCLE201600129 Application 2016-05-31Application for Zoning Clearance
CLE #
a � b
O CE SE ONLY
PLEASE REVIEW ALL 3 SHEETS Check # Date:
Receipt # _ 110 S/ 7a3 Staff:AMA—
PARCEL INFORMATION
Tax Map and Parcel: Existing Zoning S11.IG, FAN.
Parcel Owner: n2 &f* J C�ht" - -TAWZ j 1 iJ
• Jusis 7.a*
Parcel Address
.' 41��,1QAtjj2 (Z Rp• City t E&W%C - State VA Zip2 14
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? lkoyjEM Caucirk — SkyiEC3
Address: t37 L' L.&F[LS -C VUk(�T City Krs"LC d, State \/A Zip r
Office Phone: 4M1 9s 4roeQ7 Cell # ZZa Z!f 30 Fax # E-mail a n n E (E co u Ch
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APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use ✓ Change of name New business
Business Name/Type: A �/`% �F�A u;& . �l `]
Previous Business on this site ? W couGaPa6Las
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: —
-LAtFT I?-QARYJNa SPACIES, I VF-JAtCJR --
*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 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 knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signatur(]— _ —��c-Q _! Printed A" WEytr,- Ccue-kk _SA KEB
APPROVAL INFORMATION
Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 9774511, 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 6 d &
Zoning Official Date
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 / Nt)
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y ):/
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' es
Is parcel on rivate 7el'
or public water?
If private we , ealth Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE_
Circle the one t applies
Is parcel on ept, or public sewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoniniz to complete the following:
Reviewer to complete the following:
Square footage of Use:II
I
01 N
Permitted as: re/
Under Section: 4[
Supplementary regulations sectio
�rP 1-z
Parking formula:
Required spaces:
Y/N
Items to be verified in the field:
Inspector: Date:
Notes:
C'r L �% N P,�✓y f
Viola�tkons:
If o,'1Jist:
Proff
If so,
Vari ce:
YlT
If so, is
IN
so, List: 5--.6
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, 7—a &41 gia 0
[County application name and number]
was provided to A _ Co UrneM the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number by delivering a copy of the application in the
manner identified below:
Hand delivering a copy of the application to _ NIrL L-Q IZE�D �_ C&rA
[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
Q 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 satisfies
this requirement] .
Signature of Applicant
—�PRJ65_
Print Applicant Name
5IZA(a
Date
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