HomeMy WebLinkAboutCLE201600151 Application 2016-07-14Application for Zoning Clearance
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CLE # 20110-151
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # CAS 14 Date: (o )345 11 t-�'
Receipt # 1 05001_ Staff:
PARCEL INFORMA
UO!4-7Existing Zoning eA hrnm"Lw
Tax Map and Parcel:
Parcel Owner: IVY LLL � preptr+y mank5e.r Ctmli4c, S0.+i 0.)
Parcel Address: $15 0Id Ivy Way 546 SOA City Ch4e16' te5v►liC State VA Zip -22963
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? All i c X11 I•C)Knet'
Address: 315 Old I V V WU 5+c 3051` City ChArloftasv+ 11c. State VA zip a 4403
Office Phone: ( ) 52 V 8327 Cell # Fax # E-mail ^11;4L 0 99 r1rh Aa • corn
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: Q CdLpi+@J MAn of Z P (18m ♦ h c
Previous Business on this site eAft Ge VSA
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicles, and any additional information that you can provide: Sa.U I1 i:k office. 0-f Corr►panu 6"e d in
NYC. a #'c AN1— 16 FM; 2 erApt&VM$j 020 i&+AJAcelic 3 i crson
*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.
Signature _ Lam1( l�iC.H/Y[�•f Printed A fI i t Mi f chnC.r
APPROVAL 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 Date 6
IL
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:
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Is u m LI, HI or FDIF zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
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Will �tere 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 or later?
If private well, provide Heal artment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that aptublic
Is parcel on septic orfsew�
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: J 0
YIN
Permitted as: d C P -
Under Section: L `
Supplementary regulations section:
Parking formula:
Required spaces:
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Items to be verified in the field:
Inspector • Date:
Notes:
Violet' ns:
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If so, ist:
Proff s:
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If so`,�ist:
Vary ce:
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so, List:
SP's:
YIq)If
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 (Home Occupation, Zoning Clearance, Zoning
Administrator Determinations or Appeals, Sign Permits, Building Permits) if the application is not the
owner,
1 certify that notice of the application,
[County application name and number]
was provided to l V V L Z C ! C colo l i nt Sa+i rd. the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number 315 0 l d 1%03 wgy Ste 30-A by delivering a copy of the application in the
manner identified below:
Hand delivering a copy of the application to 64sol l ne— Saa4f (-& .
[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 (o 1301ICo
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 satisfies
this requirement].
C"W .
Signature of Applicant
Alfie. hirchner'
Print Applicant Name
G /3a/Ilo
Date
15