HomeMy WebLinkAboutCLE201600184 Application 2016-08-26Application for Zonin Clearance
CLE # q
OFFICE UbWq
PLEASE REVIEW ALL 3 SHEETS Check #
Receipt #
1 (9
Dale: ]0
tit a 1'I':
PARCEL INFORMATIONy`,��
Tax Map and Parcel: 0 1 YVU - p5!CG—C)1 q A p Existing "ZoninQ'(
Parcel Owner: IPM but4air k 0Q CQ- ip- T LL D tiS
Parcel Address: e)035 end S+. 5,,, In, ( SO City C harld' CSdi I If, State V
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project?
ir-SS1.e wry
zip9tagol
Address: 41P113 Rk-c-hrrjond Rd City Vtss-oi c-K State Vq - ". • -Dalm1
We Wvfed
Office Phone: K( 34Cell #(`-&4j 53t -S6tok Fax # E-rnUiI rt e ei scar+
APPLICANT INFORMATION
Check any that apply:
Change of ownership
Change of use ----- Change of name ' t Mess
Business Name/Type: W ih 1 n'15 i e. S inC T
Previous Business on this site L- an q F-or-d P o%.r
Describe the proposed business including use, number of employees, number of shifts, available parkin ,u.: : 'wr of
vehicles, and any additional information that you can provide: 5 --] e.rri p Loy!P[TI or -..A
*This Clearance will only be valid on the parcel for which it is approved. if you change, intensify ur nx)N-c the use to a nr•r 'Zoning
Clearance will be required.
I hereby certify that I own or have the owners permission to use the space indicated on this application. I also certify that t�n rrovided
is true and accurate to the best of my knowledge. I have read the conditions of approval`. amend t understand"dicn_ and that t
Signature64Q iJ
Printed e-SSI f •_ �Ci �'
APPROYAL INFOkMATION J
�Q Approved as proposed [ ] Approved with conditions ] D-'
[ ] Backflow prevention device and/or current test data needed for this site. Contact AC'SA. 977--1 ti 11. xl 17.
[ ] No physical site inspection has been done for this clearance. Therefore, it is not a deterniination ofcorn^'' �'V"'ing
site plan.
[ ] This site complies with the site plan as of this date.
Notes:
Building Official
Zoning Official Date _ flzel ba
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 9"7
ftcvist :: of 3
Intake to complete the following:
YIN
Is use in LT, HI or PDIP zoning'? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /QNWilre 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�=vwatere.
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 ubl�i ?
YIN
Will you be putting up a new sign of any kind'? If so, obtain proper
Sign permit.
Permit #
Y
WiINTere be any new constntction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the followin
Reviewer to complete the folloir
Square footage of Usc: J
6 / N
Permitted as: r'4A,
Under Section: 41. Ice, C._(i.-
P
Stipplementary reOulations section:
Parking formula: l//
a �AA
Required spaces: O
YIN
Items to be verified in the field:
Inspector : Dw
Notes:
Violations:
Y /
If so, ist:
Proffers:
N
qTso, List:
d l—
—•___.__ __._ . _
Variance:
Y/Ic)
If so, List:
SP's•
Y/0
If so, List:
Clearances:
SDP's
Rey iscd 1 1/1 " I
CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE ILANDC \Y
This form must accompany zoning applications (Home Occupation, !.o►ting Clearance, 7w-;—
Administrator Determinations or Appeals, Sign Permits, Building Permits) if the upplicati,— is),
owner.
I certify that notice of the application,
[County application name and numbc
was provided to AjbeMc:Z � � iW-ie owner of record r'
[name(s) of the record owners of the parcel]
and Parcel Number (pl l.> O - D — by delivering, a copy of the app!�-;ttlon
manner identified below:
Hand delivering a copy of the application to C� .r)C-,—e r Y1+ C iaC 1s`l;
[Name of the record owner if the recor- 4tr
person; if the owner of record is an entity, identify the recipient of the record and the 'J
title or office for that entity]
on
Date
Mailing a copy of the application to _
[Name of the record owner if the record owner
if the owner of record is an entity, identify the recipient of the record and the recipi-
office for that entity]
on
Date
to the following address:
[address; written notice mailed to the owner at the last known address ol' the owner
the current real estate tax assessment books or current real estate tax assessment rec
this requirement].
U'
S tore of Ap li ant
Print Applicant Name
..J.Pp
Date
-2, (.) :fj, �� i