HomeMy WebLinkAboutCLE201600233 Application 2016-10-10Application for Zoning Clearance"
CLE # _ a)11r u v�3?�
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Date:
Check# 1�[
Receipt # Staff. s 5-
-
PARCEL INFORMATION „ ,
Tax Map Parcel: G
and Existing Zoning (�Cf
Parcel Owner: 1 G (J!5% 1 L-ftlyknE S. I h G
Parcel Address: 7 �+�F rtW �gy 14 2D1City V1 1 0111CState � Zip i�
Mite
(include or floor)
PRIMARY CONTACT /J
WC624
Who should we call/writeA concerning this project? Ari& C
-��!
Address :_ �, InL'7lUl'F-t �°{/� [.I City State Zip
Office Phone: Cell # V110 Fax
/Y1Cilf I , Cb711/i
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of nameNew business
Business Nameffype: Z ` G GI' C71 1<kvjnW4talti
Previous Business on this site
Describe the proposed business including use, number of employees, num er of shifts, available parkin spaces number of
'on
vehicles and any additional informa that you provide: b L
'UtLM'lYA ,j-
*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. 1 also certify that the information provided
is true and accurate to the best of my know] e. I have read the conditions of approval, and I understpandd them, and that I will abide by them.
Signature Printed I�w�v� �lC� i�lGC4
APPROVAL INFORMATION
Approved as proposed [ J Approved with conditions ( J Denied
J Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, x 117.
1 No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
site plan.
[ J This site complies with the site plan as of this date.
Notes:
Building Official Date f._0 E o t C
Zoning Official f Date /0�Q�Z _
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
Revised 11/02/2015 Page 2 of 3
Intake to complete the following:
YIN
Is use to LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y I
Will a 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 o li ?
If private well, provide H part nt form.
Zoning review can not begin un we receive approval from Health
Dept. FAX DATE
Circle the one that ap
Is parcel on septic or tnsewe
YIN
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 following:
Reviewer to complete the following:
Square footage of Use:
0 I N b l4p—
Pernnitted as:
Under Section: 2� Z-
Supplementary regulations section:
Parking formula: V, a
Required spaces:
YIN
Items to be verified in the field:
Inspector • Date:
Notes:
Violations:
YI
>-a st: If so,
Proffers:
Y1
If so, ist:
Varia ce:
Y /0/
If so, List:
P's:
N
If so, List:
Clearances:
SDP's
Revised 11/112015 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,
was provided to
[County application name and number]
[name(s) of the record owners of the parcel]
and Parcel Number
manner identified below:
Q 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
0 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].
Signature of Applicant
Print Applicant Name
Date