HomeMy WebLinkAboutCLE201600130 Application Zoning Clearance 2016-06-27P
Application for Zoning Clearance
CLE # "' 1
OF ICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS Check # ;7,,?- Date: b
Receipt#_L 7f Staff: �,�r-t
PARCEL INFORMATION
Tax Map and Parcel: � �``� r7 i i Existing ZoninJg 1�om
Pared Owner: i �f it7 / f,6 P7 i _me- Akl) -'/ d.l- .
Parcel Address: /Ago i V/l'��i fefJ, _ City 01r�C116 State A Zip 27,
(include sui or floor)
PRIMARY CONTACT f
Who should we call/write concerning this project? _ y -
Address • ►0 Zj ,*-171 W cafnd W city 7State zip
Office Phone: l59-U 74 1 rycen it S Zx # E-mail
// C41',
APPLICANT INFORMATION
Check any that apply: Chan of owaersbip Change of use Change of name New bus%evs
� r.
Business Name/Type: aur t�-� �n( "Lo (�
Previous Business on this site CVJ_i�'M 0 i l?,G. A-�
Describe the proposed business Including use, number of employees,
vehieJes, and ny additional informa 'on that you can provide:
*This Clearance will only be valid on the parcel for which it
Clearance will be required,
shifts, available parking spite, number
or move the use to a new location. a new
I hereby certify at 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 actor to to the best of my knowledge. I have read the conditions of appro , an � d them, and that I will abide by them.
Signature Primed
AL INFORMATION
['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 C
Dated --
Zoning Official
Date
OfficialN
4&TOther
Date
County of Albemarle Department of Community Development
401 McIntire Load Charlottesville, VA 22902 Votes; (434) 296-502 Fax: (434) 9724126
Revised 11/1/2015 page 2 of
Intake to complete the following:
Y/N
is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
0iIN
ll there be flood preparation?
If so, give applicant a Health Department form.
Zoning review can not be in til we receive approval frorn Health
Dept FAX DATE t �(
Circle the one chat applies
Is parcel on private well or public water9
If private well, provide 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 septic or 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 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: L
Airmitted as: '
Under Section:
Supplementary regulations section:
Parking formula: 0 rc4 , 57.15
Required spaces:
Y
be verified in the field:
Inspector. Date:
Notes:
Violations:
Y/N
If so, List:
Proffers:
Y/N
If so, List:
Variance:
YIN
If so, List:
SP's:
YIN
If so, List:
Clea ranees:
SDP's
I
Revised I1/112015 Page 3 bf 3
CERTIFICATION ThNf NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
This farm num accompany xonhq appAmmo ss (mom o&watfox, zoning aewww, zoning
Air Dalerm(xatlons or Appeals, S�g' n PermUr, BUMft Perm" lithe appllaa wn is not the
owner.
I certify that notice of the application, *ro
J&P
nty application name and number
was provided to the owner of record of Tax Map
[name(s) ortfie record ownm— of & parcel)
and Parcel Number Z, - -
f `� 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
Mai '8 a co of the lioaticm to L �U V
Py
[Name of the record owim ifthe 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
ofroe for tiw
on that to the following address.
Date' -
[aftess; written notice rmsiled to the dwmer at the ifisttnown address oftfie owner as shown on
the current real estate tax assessment books or current real estate tax assessment records satisfies
this requitement].
si of Applicant ---
—/ 4 .._.,
Print Appli t Na
Date
��E4 022A ptzur, PLiN^j - -?,� � 4a
IA
FK7P
,Foo t) k2-�
04k4l.,-JIL-
Application for bong Clearance
'LEASE REVIEW ALL 3 SHEETS I Meek
xecetpt 0 Sta}'l;
1'ARC'k:I. ll1'FOI�MATION --
Tas beep and !'arcel: —• ��� t.xlstingLoninp � —
Parcel 0"cr,_Xod
Parrsl Addsrxv: CJ l [ _ 7'i�
�� G statG.r�
(include salt ar l[aorj �—' - _�— --•
!R IMARY CONTACT
Who should we rwlUwrlte tonetralug this pro jtct? aY
Address :_ /0 B i
ometPhone: [7;n1 ;.&3 CellM� j..5-2-tt6rixx ...�E-mail.
Meek
Business KftM /l"?pe.:
P'reWlint Btrduess on thts stte l 4t177Gt 114, f! '7.7 &
)describe tha propoeod 2iusincae tnaludik%& 1esr, nninber of eMplWyM,
vehly4es, andj ny odditinval itriar Ma on Brett' gnu rs,e provide,
�1 fi��e. �l dip
lhls-CeVM.a r wlll o:sty be valid au 11x ps ea! for which it is appEnwc i. 1Cypn
Ctearv,ru Knit bo =QWred,
of name ,[___New br"ia07s
aluf„a, arrilable parking aglae„ oumbcr of
or movs tho use to sew loeatiaa, nn newt
[ horeby oartify trt 1 own ar 5eve the pvroer's permission to vee the specs lodtcatrA nn titlr tlrplicetian. 1 alsb rertliy that the laionnatidm provided is true end tc to tho best oftny knowledge, [have reed lire uneditioros of alproval, �� � d Ihtua, and tkrat 2 will abide h7'them.
5ig�aturo
APPROVAI, W0,9M -bON
I 1 Approved as pmpaned i j Apptovai with conditions Denied
[ ) Backtlow pmVention doviae mdlor current tent data nCeded for this site. CAnCac! ACSA, 977-4.511 xt 11.
J No phyefcal site inspection hasbren done for this clearance, llcmforc, it's not a delonaination of complianco with the exisiirrg
Site plan.
j ) This bite cnmirliea with the site plan us of this date.
Nate.s..
k;unfling oi%iew
Zoning i�fiCW-
Oth r Official
r.:orrmTFR
y W Alflf rit Ttrparlhitilt or Cuorrmunit} iitvrltli#,urnt �'
402 M1'2c2ntiro Ro:d Chkrlottravlllo, VA 72901 Voice ('13-112$6-5R U I'm a; (4M 972-4224
Revised 21/In015 Page 2 of3
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