HomeMy WebLinkAboutCLE201600157 Application 2016-07-25Application for Zoning Clearance
OFFICE USE ON
PLEASE REVIEW ALL 3 SHEETS Check # 00 VE 153 Date: 1 I?
Receipt # Staff:
PARCEL INFORMATION M Tax Map and Parcel: 1 �� r `�Y Q� 'Q�� �Q�QQ Existingzoning DEG
Parcel Owner: S.T eolllo r cJ'1711��rLtjf,ef
Parcel Address: City State V/! Zips
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? EV-,g r7D
Address: Eth Sttt'Ct Rxa jodl City eharld �yl �IG State VA Zip
Office Phone: 6Lj/L') , V33 -lg68 Cell # Fax # E-mail Manowe4-lioz Oct -cons
. u.l1f„ doj - toM
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name x New business
BusinessName/Type: DILK'S SAORT: & 66DDs
Previous Business on this site
Describe the proposed business including -use, number of employees, number of shifts available parking spaces, nu�mber6of
vehicles, and any additi nal information that you can provide: Ott I/ Sal_-J 07 e-1a�irrn2, fij w r T'rrearmd
*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 t t I own o have the owner's permission to use the space indicated on this application. I also certify that the information provided
is true and accur to the t of my knowledge. I have read the conditions of approval, and I understand tth_emj, and that I will abide by them.
SignatuL Printed -TAn � �T 11 -ew
4PPROVAL INFORMATION
[� Approved as proposed [ ] Approved with conditions [ ] Denied
[ j Bacltflow prevention device and/or current test data needed for this site. Contact ACSA, 977-451I, x117.
[ j 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 Offiicial Date N-.,
Zoning Official a Date0
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5332 Fax: (434) 972-4126
Revised 11/02/2015 Page 2 of 3
CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
This farm 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, C. em-o -h} p 1 �em arl e,
(' _ r f [Coy application name and number]
y was provided to • [-a r `r n S 'En kre"1 S e I the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number 0 7 4MI ` 06 - 06 - DQ,xo i) by delivering a copy of the application in the
manner identified below:
Q 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
Date
5Z Mailing a copy of the application to S J. e0I&S t o fer r e
[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 to the following address:
Date
5JiAj F3road .Sfyeee, Li-k6 Po &,t alf 1--Q1-f6ura , 6-4 Ada I3
[address; written notice mailed to the ownef 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
Stdaf6re of Applicant
A
Print Applf6ant Name
Z a Ll (o
Date
Intake to complete the following:
Y /0N}
Is u W LI, Hl or PDIP zoning? If so, give applicant a Certified
Engineces Report (CER) packet.
Y l
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 uEppaMritEntf
If private well, provide He orm.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic public sewer.)
VY� N
ill you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
'Permit # &- fias and I4 17d
YlN
ill there be any new construction or renovations?
If so, obtain the roper Permit.
Permit#
3jjj1 jn j Paerin.,t
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: �b
6 / N
Permitted as:
Under Section: �S. 2 • .
Supplementary regulations section:
Parking formula: ltlsl
joOj
Required spaces:
Y I :1
Items to be verified in the field:
Inspector : Date:
Notes:
vio1 �bons:
Y/W
If so. List:
Proffers:
JO/N
f so, List:
Q
Maria ce:
Yl0
If so, List:
SP's:
Yl(8)
If so, List:
Clearances:
SDP's
Revised 11/1/20I5 Page 3 of 3