HomeMy WebLinkAboutCLE201600239 Application 2016-10-21Application L
ning Clearance
CLE I'm
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OFFICE Y E
PLEASE REVIEW ALL 3 SHEETS Check # NLDate: • 0
Receipt # Staff. /VJ __
PARCEL INFORMATION
Tax Map and Parcel: �� �tii - A — Existing Zoning_
Parcel Owner
Parcel Address: DD�MMMWQAtV Cit
(include suite or floor
PRIMARY CONTACT
Who should we call/write concerning this project? c
Address : 236h
�} f , ity
Office Phone: (� Cell #4 `d_X7Y [Fox #
E-mail
Zip
Zip
�12
APPLICANT INFORMATION
Check any that apply: Ch nge of ownership Change of use Change of name New business
Business NameiType:J d �� �' l "� ):r f I
Previous Business on this
Describe the proposed business including use, number of employees, nu ber of shi avail le arking s ac nu ber of
ve icles, and an additiona information.4hat you can p ,ide:
*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 accura the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed
APPROVAL INFORMATION
[ ] Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 9774511, 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 Cot Za [ 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 /l/2015 Page 2 of 3
Intake to complete the following:
Y l
Is use I, HI or PD1P zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y
Wil] 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 we of pu ter?
If private well, provide alth artment form.
Zoning review can not begin until we receive approval from Health
Dept, FAX DATE
Circle the one that a13pLies
Is parcel on septic or publ' er?
YIN
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
YIN
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to coMnlete the followin
Reviewer to complete the following:
Square footage of Use: _
$IN
Permitted as: +�
Under Section:
Supplementary regulations section:
Parking formula: /��
Required spaces:
YIN !�
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
YI tt:
If so,If
Proffers:
Yl
so, st:
ariance:
/ N
If so, List: �y
SP', �
Y I�1�fJ
Ifs gist:
Clearances:
SDP's
Revised 11/1/2015 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) ifthe application is not the
owner.
1 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:
the owner of record of Tax Map
by delivering a copy of the application in the
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]
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].
Signature of Applicant
Print Applicant Name
Date
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FWht WoUl
F�"
a
is
MDJECT NAME:
[DESIGN ENVIRONS CORPORATION REMIONS.
DATE; By,
DESIGNED - SLULT • FURNISHED • IP49TALLSD
SINCE 197a
DRAWN BY:
CHARL❑TTESVILLE, VA
DAM SCALE.
34D GREENBRIER DRIVE CHARLOTTESMUS, NARGiNtA 229M
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