HomeMy WebLinkAboutCLE201600174 Application 2016-08-08T 0 fmi 4t —Z AD I (ov 0 1 LtOq
Application for Zoning Clearance 0.,
CLI':N—Wt4 —l—ILI
OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS Check# t?3lJgpK vate: Z [� _
Receipt # 10TSM Staff: A
PARCEL INFORMATION C—A
Tax 111np and Parcel: ` Existing Zoning —J..
Parcel Owncr:��P R-c-&L- I � i—LC.
Parcel Address;_Jg b_ _5em:rte ft jL 1 City v esY:� a State j} zipu,70if
(include suite or floor)
PRIMARY CONTACT Who should we call/write concerning this project? .ii/&V die-1
ijy
Address : P. 13 v City i'j' ar bb4A State
0flice Phone: Lf0- ' 3 Cell # Fox t1 G-maii ne.�
$Ae�,¢ef,eenr —
APPLICANT INFORMATION
-Check any that apply; Change orlownership Change of use Change of name New business
Business Namcfl'}pe: �Dyvs J /Z1AGL. i ...... _....., . „, _......_.
Previous Business on this site
Describe the proposed business including use, number of employees, number of shills, available parking, spaces, umber of
vehicles, and any additional infurnin(ion thni you en provide.: _/.Qet ryees • -gA.PA-C , i�t_°��'c
'This 0enrance 5% ill on!) he %and on the pureel fcir which it is upploved ]rgr5u change. tntensifv nr nncnve the us5 to a new locr�tiun, a new /.11ama
Clearance A%iII he required.
I horeh} certify the[ I own or have the owner's pernntsslon to use ilic space indicated on this application. I also vcriify that ll1C mrurination pruY'nded
is true. and accurate to the best army knowledge. I have read the conditions of appraval. tend I understand them, and that I ivill abide by them.
Signature
APPROVAL INFORMATION
XApprnved as proposed I ] Approved with conditions [ ] Denied
j ] Backfl(,%r prevention deice andior current test data needed for this site. Contact AC5A. 977-451 1, x 117.
I ] No physical site inspection has been done for this clearance. Therefure. it is not a determination of compliance with the existing
site plan.
I ] This site complies with the site plan as of this date,
Notes
Building Official Ditle _ �/ f 'ZL 1 tom.
Zoning Official Date / J
Other Official Efate
County of Albemarle Deparlment of Community Development
3111 McIntire Road Charlottesville, VA 22902 Volce: (434) 296-5832 Fax: (434) 972-4126
Revised I I li2t)I S Page 2 of 3
Intake to complete the following:
Is use in 1.1, 111 or PD1P zoning? If'sa, give applicant a C'crtified
Eineineer's Repurt (C ER) packet.
1' 16)
Will there be food preparation?
1(so, give applicant a Health Depanment fornt.
Toning review can not begin until we receive approval Pram Ilealth
Dept. FAX DA,rF
Circle the one that applies
1s parcel on private well or u4ic water
Ifprivate wall, provide Healt partment Corm.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE _`
Circle the one that applies
Is parcel on septic or ublic ewr
5) N
Will you be putting up a new sign ofany kind?
Sign permit.
Permit #jn
If su, obtain proper I
1) \
Will there he any neu construclion or renovations?
If so, obtalir thqe proper Penim.
Permit Ilp),lp-0140AC
Zoning to complete the following:
Reviewer to complete the following,
Square footage of Usc: tJ bKbI
—
PN
n,itted
tlndcr Scetion: �-
Supplementary regulations section -
Parking formula: f
Required spaces:
Y1
Rents to be verified in the field:
fr=spector
Notes:
Date:
Viola rocs: —T-- •--�--•-•----
f f 5U.51:
Proms!
11'SU5C
Ifso. fist:
1fso. List:
Clearances:
SDP's
6� S
Re%ised 1,2015 Page 'I of I
CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
This jorm 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, IV / w" do. /3abil. - a J4 09 AC
[County application name and number]
was provided to R-„$p Ra� a L& A4 ili the owner of record of Tax Map
[name(s) of the re orft d owners of the parcel]
and Parcel Number &5 0 , _ $,ai 1 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 10 rJca &"_ / I e
[Name of the record o4kney 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 7/ur'%1G— to the following address;
D T
[address; written notice mailed to the owner at the last ffhown. address of the owner as shown on
the current real estate tax assessment books or current real estate tax assessment records satisfies
this requirement].
Sign ureofApplicant
print Applicant Name
71,v7/%1.
Date