HomeMy WebLinkAboutCLE201600236 Application 2016-10-27Application for Zoning CIearance
CLE # __
OFFICE XY—
PLEASE REVIEW ALL 3 SHEETS Check tl Date:Receipt 0Staff:
PARCEL INFORMATION
Tax Map and Parcel:
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Parcel Owner: —_ � j n'�i RprW "k-
Existing Zoning lf t5 tt t wi e rzi iY
Parcel Address: - I I e o r-�- ['i ;+- - to , % City l V �%('i r {wpagtate Vr I Zip
(include suite or floor)
PRIMARY CONTACT
Who should
�we%call/write concerning this project?
Address j' r ?)oX 33 ll/ City No T'+ r t Wqlf,�- State Irk Zi� t
c� p
Office Phone: ciiD dot Cell tY F7S Oct) Fas 4 f✓ E-mail�t
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use
Business Name/Type:� • N-S
Previous Business on this site tG r cJjV-( C7ovJ l ��
Change of name ew business
Ale /-mil4-4
Describe the proposed business including use, number of employees, number of shifts, available�arkingpaces, number of
vehicles, and an additional information that you can provide: -tier
��->ti �-u✓ yYI D, � �P�� fZ% L �r �r rh 9 {�,- , ( '.j , Z - �f'r+fJo—r,'�e'�
'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 newLonin
Clearance will be required.
I hereby certify that I own or have the owner's permission to use the space indicated on this uppJication. I also certify dial the infornatiM.' provided
is true and accurate to the best of my lmowledge I have read the conditions of approval, and 1 understand
them, and that 1 will abide by them.
Signature "l G t "2Z Printed n'l ! �1 kLJ
APPROVAL INFORMATIO
[ ] Approved as proposed �-J ) Approved %vitld conditions [ ] Denied
[ ) 13ackflow prevention device and/or current test data needed for this site. Contact ACSA, 977-451 1, x 117.
[ ] No physical site inspection has beer; 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
Zoning Official
Other Official
--
.A-
Date
Da lc fA
Date 101rJac) 1p
County of Albemarle Department of Community Development
401 M14clntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
Revised 11/1/2015 Page 2 of 3
Intake to complete the following:
Y /lN
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/N
ill 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
Circle the one t
Is parcel private well a public water?
If private cev+dalth Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the a plies
Is parc on septic o public sewer?
Y N
Wi be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
Bill there be any new construction or renovations?
If so, obtain the proper Permit. �l U wt� h l ✓
Permit # J f p
�QwWX ,Y1G
C
Zoning to complete the followin
Reviewer to complete the following:
Square footage of Use:
6)/N
Permitted as:i �2! �S7Ahlrt��ALI
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces: zle
Y/ io
Items to be verified in the field:
Inspector:
Notes:
Date:
Violations:
Proffe s:
Y/�
Y/Mj
If so, List:
If so', -List:
Ya7N
O/s N
If so, List:
If so, List: S7 2, ,- 2— :7—
Clearances:
SDP's
Revised 1 ]/]/2015 Page 3 bf3
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, Z 6 (AC i C �'�' r vi c-�,
[County application name and number]
V `�J
was provided to f { k-er �Am bsC�, the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number by delivering a copy of the application in the
manner identified below:
n
Hand delivering a copy of the application to V� �1(' % ld M 6�d-v
[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 l0/ 13 16
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
t�'d-ham.
Print Applican Na e
laI IL
Date
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