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HomeMy WebLinkAboutCLE201600210 Application 2016-09-23ApnUcation for Zoning Clearance CLE # c�16 - /D PLEASE REVIEW ALL 3 SHEETS Cheep a Receipt Date- Staw.- PARCEL INFORMA7i6flfl0-[-((..p,C Tax Map and Parcel: �."..'. � • _ _ existing Zoning HIG1411 AV COMMERCIAL Parcel Owner:_ _ TOWNSIDE EAST" LLC C/O INVESSTORS MANAGEMENT INC, Psrt:el Address.. ZZ ILL N-Al � lit City C�.tl Mate Up �Z (include star floor) PRIMARY CONTACT Who should we coiPwrite concerning this project? a Ar1C a' rti_o.b Address :.z tV -1yu 9-J city � l't -A e. State Zip Q Office Phone: 3�s (1 Celi N _` (45-12-1I Fax N &rnail INFORMATION I Check any that apply. -- x Change of ownership Change of use Change of name New business I Business NamwType:-- _ �� b;:,,X J^ C 1btr;1 f-Qx_4S �-reSk 6- %e*,(T .4 — Previous 13usfnems on this site D3 tl S Ictst, 6A1 Describe the proposed business including use, number of employees, nu�ber ef�s fPts, nvaiFa�ie g sptees, number of vehicles, and any additional information that you can provide: �_—_ . - v *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 now losing Clearance will be required, 1 hereby certify that I own or have the owner's permission to use the space indicated an this application. I also certify that the Information provided is true and accurate to the best of my knowledge, I have road the conditions of approval, and [ understand there, and that [ will abide by Hisao. Signature O. iW Printed IS .& �i 01. 1 t e a APPROVAL INFORMATION Approved as proposed [ ] Approval with conditions [ Denied [ ] Backilow prevention device and/or current last data needed for this site. Contact ACSA, 977.451 i, x]17. [ ] No physical site inspection has been done for this clearance. Therefore, it is net n deterntinatlon of compliance: with the existing site plan. [ ] This site complies with the site plan as of this date, Notes: Building Official — Date Zoning Official ©tiger Official e-z—,; e / 1/xlr/ I VfI47 /ff r�'-l'6ate 1 .• County of Albem2rle Departfnent of Community Development 401 Ililcirt re Road Charlottesville, VA 22902 Voice: (434) 2%-5832 Pee: (434) 972-4126 Revised 11/1/20I5 Page 2 of 3 Intake to complete the following: Y /O Is use in LI, HI or PDIP zoning? Engineer's Report (CER) packet. If so, give applicant a Certified PilN l there 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 X19 Circle the one that applies Is parcel on private well or rc w er? If private well, provide He ent form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that applies ... Is parcel on septic o ublic sewe Y/N Will you be putting up a new sign of any kind? Sign permit. Permit # If so, obtain proper YIN Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # Zoning to complete the followine: Reviewer to complete the following: Square footage of Use: p' 2-y � 3�)/ N Permitted as: (-4?4jttrQ j J4 Under Section: )--q. Supplementary regulations section: Parking formula: // /L _ Regrired spaces: YI Item` be verified in the field: Inspector Date: Notes: r,9niw"" dlwlNP r n C�le1 viol vtins: Yl If so,t: Proffers: Y1 Ifso',-List: Variance: Y/E) If so, List: SP's; YIDT If so, List: Clearances: SDP's Revised 11/l/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. I certify that notice of the application, 00 a C 0,A r [County application_name and number] was provided to [name(s) of the record owners of the parcel] and Parcel Number manner identified below: Hand delivering a copy of the application to the owner of record of Tax Map by delivering a copy of the application in the [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]. _._ Sig►ia ureturet of Applicant �)/Onc-q, qP I I,\, Print Applicant Name 109 /M 116 Date