HomeMy WebLinkAboutCLE201600232 Application 2016-10-10Application for Zoning Clearance
CLE # Qq�a :1
OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS Check # I $j Date: �j_
Receipt # Staff: Ln
PARCEL INFORMATION ua-- — —
Tax Map and Parcel: o c izo -03 - op — --7 d Z 00 Existing Zonin ib 1A
Parcel Owner: Aoie (;
Parcel Address:IY16 $iVC-1rerj0N A-i11a CityC.& Y-sic lL State Y Zlp ZZL
(include suite or floor)
PRI=Soldywe
CONTACT ]
Who call/write concerning rthis project? 411(A I'?7J'd l F4iY�`l d,L
Address: 20- Ten?7 5 City 64U `0hW/ _State Zip
Office Phone: %b 9 ao 3 1 5� Cell # a Fax # E-mail i11 I I f.Z u k a ra
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: c Up onc r t)- c-p—
Previous Business on this site
Describe the proposed business including use, number of employees nu ber of shifts, ava']able par 'ng spaces, number of
vehicles, and any additional information that you can provide: r
"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. I also certify that the information provided
is true and accurate to be of r
wledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed MIL 4 _Z//77)"0?_MA`1J
APPROVAL INFORMATION
Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, x117.
[ ] No physical site inspection has been done 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 _ -- t Q (A 1 1 L
Zoning official Date -
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 /1/201 S Page 2 of 3
f
Intake to complete the following:
l�IsYu LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y l
Will re 6e 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 �b�bcter?
If private well, provide Hement 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 rc s e
Y /�Wil you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y l
Wil • e be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to comolete the followin
Reviewer to complete the following:
Square footage of Use: ( V
� �
/N
ermitted as: rQ, t—A /11tVj GQ,
Under Section: -;_ J
Supplementary regulations section:
Parking formula:
Required spaces:
Y/(I
Items to be verified in the field:
Inspector; Date:
Notes:
1
Viola 'ons:
coffers:
Y/
IN
If so, ist:
f so, List:
Vari ce:
SP's:
Y
(D/N
If s st:
If so, List:
Clearances:
SDP's
Revised 11/1/2015 Page 3 bf 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:
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].
- /XZ�Z
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Sig re of Applicant
J'v)ILA ZIf" r ?02-"A'ry
Print Applicant Name
to / ?10 _
Date