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HomeMy WebLinkAboutCLE201600172 Application 2017-01-17Application for Zoning ClearanceJ'"�' CLE # - f i2, Y ,, _201U, PLEASE REVIEW ALL 3 SHEETS OFFICE USE ONLY Check # _,q Date: Receipt # 6 5y-7 S Staff: ) �' PARCEL INFORMATION Tax Map and Parcel:04<0 J — d 0 - d 0 r 1 OW 6 Existing Zoning t .e7bV,Y1ni /l to Parcel Owner: K NcivitiA PI r 7-Lt S p LLG Parcel Address: 2 i Gtvt✓i�t / J2� �( �� ( Gt ✓ City i�i, BSy, & State Zip z?`lvi (include suite or floor) PRIMARY CONTACT —�-- Who should we call/write this M E711/ concerning project? ay V f vt .i—SGtlit f. C+tom Address : 3qJ - y �r'r Way City L"I-Llj r lohe-sV [ 11 State VA Zip-22-q / Qz+ee Phone: pit{ 52-q— (E{o' CeII Fax # E-mail r Y +� ih l�Cr��G�fl6v�Lc3s / AYYLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name j( New business Business Name/Type: LL--o© Previous Business on this site S4 *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 the best of my /owl e. I have read the conditions of approval, and I understand them, and that I will abide by them. Signature Printed Al2Al &I APPROVAL INFORMATION >TApproved as proposed [ ] Approved with conditions [ ] Denied [ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, x1 17. [ ] 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 Zoning Official Other Official VDA" Date Date !k��/' 7 Date County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126 Revised 11/1/2015 Page 2 of 3 Intake to complete the following: Y / Is u n LI, HI or PDIP zoning? Engineer's Report (CER) packet. If so, give applicant a Certified V/ N l there be food preparation? If so, give applicant a Health Department form. Zoning review can not begin u il. we receive approval from Health Dept-9-AN DATE Circle the one that applies V Is parcel on private well or chepwlKent ic water•? If private well, provide Heal form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that ap 'es Is parcel on septic o publ�sew, N 'twill you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # VN ill there be any new construction or renovations? If so, obtain the proper Permit. Permit # sqC , _ " Zoning to complete the following: Reviewer to complete the following: Square footage of Use: 1� VI) 13ermitted a2.16 11 lQ Under Sectio r Supplementary regulations section: Viol^ons: Y/(N/ If so, ist: Pro er : Y/N If so, List: Varff�k-hl e: YIN) If so" -,List: P's: Y/N so, List: 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) if the application is not the owner. I certify that notice of the application, AP,7111'1'aii-0n ✓1 r i ea ru rtGe [County application name and mber] ` GG was provided to 1 V&S'l Vi G l[ ht SPL L L Cthe owner of record of Tax Map [name(s) of the record owners of the parcel] and Parcel Number 0 L 2)0 - 06 '00-1 QV 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] on Date Mailing a copy of the application to Rio w na Pp -7,44 S1 C LL C [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 2 to the following address: Dati tzc0 PC95iovi ke02 [address; written notice mailed to tho/owner at the last known add of the owner as shown or, the current real estate tax assessment books or current real estate tax assessment records satisfies this requirement]. Siig/��nnnatu e o pplicant CYIGcrrv��N Print Ap licant Name 7 17-6/I (P Date \§i7 I � ~� � ) ^ \} VACANT mg Green = Wails Red = Sales Counter Orange = Electrical Outlets Purple = Overhead Lights: lines for track lights circles for pendants squares for can lights Note: Annotations are not to scale)