HomeMy WebLinkAboutCLE201600140 Application 2016-06-10Application for Zoning Clearance
CLE # 10 0—
OFFICE %A,
LY`1f;�PLEASE REVIEW ALL 3 SHEETS Check#Date:
Receipt # Staff:
PARCEL INFORMA N
Tax Map and P reel: - Existing Zoning
—L
l +
Parcel Owner. /I
Parcel Address:
ads' ZMAWmg&1j& bZyc'C"City r h asi p 4 K/,t. state zip 1.116I
(include suite or floor)
PRIMARY CONTACT n _
Who should wee call/write concerning this project? �n ha
Address: le Am In- City + A f State U14 , zip 2.30 b 3
Office Phone: &} .SSA •38SF0 cell #10f 920 &5 / Fax SS G E-mail Q�Ic !c � g�Q . Ca �..lr ,R
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: ,4920-C __ �17fA5 ?UC L "Ieklevs
Previous Business on this site I u-S Is 1W 4
4iu-
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: 04e- : 1&0 0 jALIds Lte
*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 best of my knowledge. I have read the conditions of approval,m.
Jand I understand them, and that I will abide by the
Signature Printed ok-I -R. A M ps
APPROVKL INFORMATION
Approved as proposed [ ] Approved with conditions [ ] Denied
] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, x 117.
[ ] 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 a Date 61(01((. _
Zoning Of dal Date l�b )2b16
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 11/02/20I5 Page 2 of
Intake to complete the following:
Yl
Is use n U, 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 n c ter?
If private well, provide He th D ter?
form.
Zoning review can not begin until we receive approval from Health
Dept FAX DATE . _ _
Circle the one that appl
Is parcel on septic or p 'c sewe
YIN
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 #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: S� t
YIN
Permitted as: O
Under Section: 2-3. 2 y
Supplementary regulations section:
Parking formula:
Oy7 !VK!
Required spaces: - ,
Y/N
Items to be verified in the field:
Inspector:
Notes:
Date:
Violations:
Yl�
If so',List:
Proffers:
YI
If so, ist:
Vari ce:
YI
If so, ist:
SP's:
YI
If so, ist:
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 (Some 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, XLG
``�� p [County application name and number]
was provided to �r4�i 61Q p_ 9. 601-s� Q.p ro eial, -rx". �- the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number DV / W 0 --O /- 08 ._ 006 ®O by delivering a copy of the application in the
manner identified below:
EZJ"Hand delivering a copy of the application to Ativ & [" A)Cw ,
[Name of the recAl 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
0 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].
zqze4��
Si&p& of Applicant
Print Applicant Name
- -a ,r-14
Date
APPLICATION FOR ZONING CLEARANCE
AMOS & AMOS PLLC
2305 COMMONWEALTH DRIVE, SUITE C
CHARLOTTESVILLE, VA. 22901
FLOOR PLAN
FIRST FLOOR; SUITE C.
�.ca,c: moo