HomeMy WebLinkAboutCLE201600149 Application 2016-08-02Application for Zon'ng Clearance
CLE # � — 1
OFFICE ONLY
PLEASE REVIEW ALL 3 SHEETS Check # Date:
Receipt # Staff:
PARCEL INFOR
Tax Map and P eel:own Existing Zoning
Parcel Owner: l o
Parcel Address:-" a 64 1* ree- ei p k6 6kity t! n� r State ✓ A zip dRrt
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? V "`'`� `�' " v
Address P% tC-ti �: [r�Z► �} _ City t! r'CiState _�� Zip
Office Phone: &3-t3 -2 Cell #'987-Qqa Fax # E-mail WIj It
APPLICANT INFORM TON -
Check any that apply: Change of ownershi ! Change of use Change of name New business
Business Name/Type: tco n..�
Previous Business on this site-�-
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: f e ^'10 14 -e p , Sh y-e- J pb� k � - --,�_
*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 knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed
AP VAL 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 - L�
Zoning Official Date
Other Official qP11Jf 10F 111471JU p,% Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
43
Revised 11/l/2015 Page 2 of 3
Intake to complete the following:
Y
Is u LI, HI or PDLP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
VY �' N
ill there be food preparation?
If so, give applicant a Health Department form.
Zoning review can not be ' yntil we receive approval from Health
Dept, FAX DATE
Circle the one that applies
Is parcel on private well ublic t
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 ap li
Is parcel on septi Epublic sewer`s
Y I""
Wil you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y (NJ
Wil ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the following:
-7-F
Square footage of Use:
O'ermitted as: L�
Under Section:
Supplementary regulations section:
Parking formula: I V
Required spaces:
YIN
Ite s" verified in the field:
Inspector• Xte:
Notes:
Vial ' ns:
Y/
If so ist:
Y
PrPist:
If S
Vari e:
Y/
Ifs st:
SP's:
YIN
If so, List:
A lift
Clearances: %15SDP's
1
�1
r
Revised 11/1/2015 Page 3 bf 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 orAppeals, Sign Permits, Building Permits) if the application is not the
owner.
I certify that notice of the application,
was provided to
[County application name and number]
[name(s) of the record owners of the parcel]
the owner of record of Tax Map
and Parcel Number 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
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].
- r D
Signa pplicant
Print Applicant Name
61PI&I _
Date
ell
.s�
�' -
Application for Zon'ng Clearance _
CLE # - J
!.n
OFFICE O LY
PLEASE REVIEW ALL 3 SHEETS Check # Date: `
Receipt # staff.•
PARCEL INFOR M
Tax Map and P eel: Existing Zoning-i
Parcel Owner:W
Parcel Address: 5213 b�- r��nlD�ct� rtCity fit+ t" State Zip.:e
(include suite or floor)
PRIMARY CONTACT ti
Who should we callhvrite concerning this project?�
Address: (1 (4cv�— City G{'a.? --_ 17 State Zip -dais)-,
Office Phone:[ 13-tf &Fa -at <Celi# g$T�ah Fax# '� F.-mail_ ac f"m�itK, tom, 11
APPLICANT INFO TION- - - Check any that a ! : Change of .ownership.,,,.—t Change of use Change of name New business
Business Name/Type: •- ,
Previous Business on this sitc
Describe the proposed business including use, number of employees, number of shifts, available parkin spaces, number of
vehicles, and any additional information that you can provide: eriq.& t� _e+i_ � vx4 • pc-r A t'
*This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move 0w use to anew location, anew Zoning
Clearance will be required.
I hereby certify that 1 own or have the owners permission to use the space indicated on this application- I also certify that the information provided
is true and accurate to the knowledge. I have read the conditions of approval, and I understand them, and that I wili abide by them.
Signature Printed
APPROVAL INFORMATION
[ ] Approved as proposed [ ) Approved with conditions [ ] Denied
[ ] Baclttlow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, xl 17.
[ ]No physical site inspection fins 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.
Motes:
Building Official Date
Zoning Official Date
Other Official .1 �' �� �'!�- - _1n1. Date
County or Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
Revised I 1/1/2015 Page 2 of 3
;41