HomeMy WebLinkAboutCLE201700011 Application 2017-01-30QZo17 -o3A,'
Application for Zoning Clearance'�'�
CLE #
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # Date: 1
Receipt # Z Staff: _ ,j:� .
PARCEL INFORMATION f� n
Tax Map and Parcel: �'[�i Vc) ZX Existing Zoning_ ��SC
th
Parcel Owner:_ � �t AM, Un Vent u1 �.� Lu
Parcel Address:%'City (,��ev:) �`e State Zip Z2�d
__
(include suite or floor}
PRIMARY CONTACT
U5 �,
Who shouldwe call/write concerning this project?
Address: `�'2o O �• IItM P D City° , State ..44Z Zip �Z
Office Phone: (�� Cell # 5011'W-Fax # E-mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of'use Change of name V New business
_
Business Nameffype: 5e #A&f� t4oy
Previous Business on this site
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, n mber of
vehicles, and any additional information that you can provide: l� Ctl p��'.Ge_(P�. ,tC-Wg�;�, w, i , X •Rkv
1M: �oc•d�i� i? Aw to -16, Ah F -b S t2,5ue. f"
rove vl� r0_1 2 ,b.k doses •,Ff - n
*This ClearInce will oni a valid 6n the pa l for which it is approved.' If you change, intensify or mo a 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 t the best of my knowledge. I have read the conditions of approval, and I understand them, and that 1 will abide by them.
Signature < 13l (7
Printed
APPROVAL INFORMATION
fiQ 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.
[ j This site complies with the site plan as of this date.
Notes
Building Official
Zoning Official
Other Official__
Date
Date
Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
.vs
Revised 7/1/2011 Page 2 of 3
Zoning Clearance Checklist
Applicant MUST HAVE the following information to apply for a Zoning Clearance:
1) Tax Map and Parcel or Address, Building Name, Suite/Unit/Floor numbers, if applicable.
2) A Floor Plan - either a sketch or an architectural drawing — 4/K4fOy 411/ e- hk; Oi�
a) If using less than the entire structure, note the location within the structure;
b) Note the total square footage of the use;
c) Note the square footage of each room or area of use;
d) Note the use of each room or area of use.
3) Certification that notice of this application has been provided to the property owner, if owner is
different from applicant.
FEES
Zoning Clearance = $3>f $ 5 4
Temporary Fundraising Activity = No fee
Conditions of Approval
FIREWORKS:
1. No person shall sell, offer for sale Aore display or discharge any fireworks in any filling station or on any
or other inflai able liquids are red o dispensed. ( de 1967 19413.) County Cod ection.,6-200 and 6
minimum of 00 ft from any as pum s/propane trlbution ink.
2. The sites all be cleaned d restor to its origi I conditio n or before h
signs, debri , and the lik .
3. A thirty 30) foot t setback all be m ' tained, Dis y shall/Ioedto Zon'Adminis tor's appro4. Building pe s shall be obtained f all proposed s ctures an
5. Sign permits shall be obtained for all proposed signage.
6. The sale of fireworks requires a special permit from Fire/Rescue department.
CHRISTMAS BEES:
1. The outside torage of combustible material or flammable materials shall be
less than 15 f t from any buil ng on the site. Any ope burning must compli
the Albemar County Code
2. The site all be clean and restored to its on . al condition on or b re h
signs, de is, and the 1' e.
3. A thi (30) foo ont setback shall be mtained, Display sha a located
to Zo ' g Admi ' trator's approval.
4. Building pe is shall be obtaine or all proposed struc and/or lighting
S. Sign permits shall be obtained or all proposed signage.
Ith.
so as t9l'avoid traffic
d so aVot to constitute
the Wrginia Statewidol
where gasoline
must be a
of all structures,
Modifications subject
izard and shall not be
Prevention Code and
This shallXclude the removal of all structures,
to avoidXaffic congestion. Modifications subject
OTHER REVIEWS:
1. Is the property on public or private water/sewer?
Private requires Health Department, Public requires ACSA review (2 to 5 days)
2. Will you be operating a bakery?
USDA review is required (approx. 2 weeks but as long as 6 weeks)
3. If you are serving prepackaged baked goods but not making them on the Premises, only Health Department will review. (2 to 5 days)
4. If you will be operating any business that is in an industrially zoned district or of an industrial nature you will need to provide a
Letter of Performance Standards or Certified Engineer's Report (a staff member will provide an information packet addressing this
requirement) (5 to 10 days as soon as the Letter or Report is received by this Department)
5. If there has been no site inspection within the last three (3) months for the parcel/site, then one will be conducted to verify that the
project is in compliance with an approved site plan (if applicable).
Revised 7/1/2011 Page I of
Intake to complete the following:
Reviewer to complete the following:
Y `1� J Square footage of Use: '7
Is us 1 LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet. N
Permitted as: M d .
Y N�}
Wil ere be food preparation? Under Section:
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from Health Supplementary regulations section:
Dept. FAX DATE
Circle the one that applies
Is parcel on private well or ublic wat
If private well, provide Health ent form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic ordq!lilic sew
Y/N
Will you be putting up a new sign of any kind?
Sign permit.
Permit #
If so, obtain proper
Y/N
Will there be any new construction or renovations?
If so, obt ' er
Permit #� 0
Zoning to complete the followinti:
Parking formula:
Required spaces: i l�
Y/�1
Items to be verified in the field:
Inspector
Notes:
Date:
Violations:
Y/N)
offers:
V/N
If so, List:
If so, List:
Variance:
SP's:
Y/i
Y/N
If so, List:
If so, List:
Clearances:
SDP's
-a
Revised 7/1/2011 Page 3 of
CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
This form must accompany zoning applications (Hone Occupation, Zoning Clearance, Zoning
Administrator Detertninations or Appeals, Sign Permits, Building Permits) if flee application is not the
owner:
I certify that notice of the application, _--R � 11� � � d
[County application name and number]
('�
was provided to 1�.��J I t,Vle-s the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number 5�� �e�*W by delivering a copy of the application in the
manner identified below: okr k ,kR �� S r lii Sc�
Hand delivering a copy of the application to
[Name of the recor 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 1l,1IlT
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].
P
P4"X1 �, (5
67 % � I — l� —Do DD �B 6
ro
o?� r►1
Sign 345e
of Applicant
�/pW
Print Applicant Name
I'r3 / 17
Date