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HomeMy WebLinkAboutCLE201700010 Application 2017-01-20Application for Zoning Clearance'` nT 20I-�- IG �.. PLEASE REVIEW ALL 3 SHEETS OFFICE USE ONLY Check # Date: L,-�(7 Receipt # Staff: JP INFORMATION Tax Map Parcel: 14 ' �, f and -J Existing nin . v ,J Parcel Owner: Parcel Address: (� ! GxI�Y�J�4r City State V17 Zip (include suite or floor) PRIMARY CONTACT Who should wee call/write concerning this project? I-,—%��/I Address : r fi' ���ij[� �l C �P (City�R //`�i�`�f' State — Zip Office Phone: Lqby do,� a Z©Cell # Fax APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business Business Name/Type: 1 _Q t1l e 6 �G� ill,.// ! ' jrG✓/!� Previous Business on this site C4 O k Describe the proposed business including use, number of employees] number of shifts, av9ilable parking spaces, num er of vehicles, and any additional information that you can provide: Z4i"-/,%/�'+ , ��/�-re,1W, 5c�� *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 1 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 accu o the e f my knowledge. I have read the conditions of approval, and Iunderstand/ them, and that I will abide by them. Signatur h_ A Printed /�"Iu(y1 '-rl� `�/�/ 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 Zoning Official Other Official Date \ -- \---) Date zz1- )" ) I Date County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126 CGS Revised 11/1/2015 Page 2 of 3 13 Intake to complete the following: Y/Ili Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y / Will Qere 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 or ublic w er? If private well, provide Hea artment 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 pub is sewer? Y/N Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Y/N Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # Zoning to complete the followine: Reviewer to complete the following: Square footage of Use: C;W 0er /Nmitted as: 0—C I i Under Section: �-,1 Supplementary regulations section: Parking formula: =T Required spaces: / Y / N l� Items to be verified in the field: Inspector: Notes: Date: Viol ns: Y/ If so, List: Prof rs: Y/ If so, List: Vari nce: If/ Ifs ist: SP's. Y/� If so, ist: Clea rances: SDP's Revised 11/l/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, 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