HomeMy WebLinkAboutCLE201600216 Application 2016-10-05Application for Zoning Clearance
CLE #,26I c0 - 21 i o = .
OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS Check # olDate: I
Receipt # Staff:
PARCEL INFORM TIO j
Tax Map and Parcel: '" . ! meting Zoonnn d Il
Parcel Owner: TO L M w .A{ 9196 C0VIJ OeEl aT
Parcel Address- 6 So Berk K*X C L City _ L' Lr-1o1$esv, lk State VGA- Zip2zqd]
(include suite or floor)
PRIMARY CONTACT l
Who should we call/write concerning this project? //?n 1) 4*V-4A qa Cw..Aa JJe r �al5
Address: G3o 12JGrkw•a,r (,,,rr/If City tJ%w+Iatfe .)k State VA Zip72—q°(
Office Phone: dN TUA 1111 Cell # 434 4$ 16110 Fax # E-mail -J_p f- _lg _�q w 1•� � q� j. z a,.q
APPLICANT INFORMATION
Check any that a ply: Change of ownersbip Grange of use Change of name New business
Business Namen"ype: 6&-'&11er5bv'I5 C&45 — v r.w'r- I K.%.l ark f - s cYh me,-%v r..bea,
Previous Business on this site Wa.1v0 Tip 4-or
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vebfcles, and additional informatio teat you can provide: Z e-wt lv ees q' Z PA- !n [L
Vf'6 any ^,Iq c� cr w�c�lc
tr nl"
4'rhis Clearance "I only be valid on the parcel far which it is approved. If you change, intensify or move the use to a new location, a now Zoning
Cleamce 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 best of my ed , i have read the conditions of approval and I understand them, and that I will abide by them.
signature Printed Te.�
APPROVAL INFORMATION
Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or cturent test data needed for this site. Contact ACSA, 97745I1, x117.
[ )No physical site inspection has been Clone 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_ .. cj�i „-, 3 t c Ga _
Zoning Of dal Date A&A Z
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5932 Fate: (434) 9724126
Remised 111i12015 Page 2 of 3
Intake to complete the following:
Y/6T
Is use m L.I, M or PDIP zoning? If so, give applicant a Certified
Sngin=es Report (CER) packet.
Y !
Wit �
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 or abli w ter?
If private well, provide H ent form.
Zoning review can not begin until we receive approval from Health
Dcpt. FAX DATE
Circle the one that
Is parcel on septic' r public s r?
N
ill you be putting up a new sign of any kind? if so, obtain proper
Sign permit.
Permit #
YI
Will ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use:
IN
Permitted as; —Z474
Under Section: 2-54 . & .1 _
Supplementary regulations section:
Parking formula:.
�i
Required spaces: ,� 7
YI
Items to be verified in the field:
Inspector: Date:
Notes: - - -
Vlolataos�s:
Y/
If so, st
Proif
YIN{,
If so, List:
Varian e:
Y/
if so, ist:
SP's:
Y/
If so, List:
Clearances:
SpIJ°s
Revised 11/l/2015 Page 3 bf 3
CERTIFICATION THAT NOTICE OF T E
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
This form mw wmvov zomv wficad�+01.�8{,dame 0C1�l�p t��, x, zoAbw atarance, zexit'
A�a1or Dderadvadans or Appeals, ftx Pe i Bmff 6 Permits) lythe appAcaf x & !lam the
amwer.
f certify that notice of the application,
[County application nine and number]
was provided to
[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)
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
m
to the inllowing address:
[address; written notice mailed to tha owner at the last known address of die owner as shown on
the current real estate tax assessment books or current real estate tax assessment records satisfies
this requirement).
Signature of Applicant
Print Applicant Name
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