Loading...
HomeMy WebLinkAboutCLE201700046 Application 2017-02-221 yt Application for Zoning Clearance CLE # o;\l - PLEASE REVIEW ALL 3 SHEETS OFFIICE USE ONLY Check # 5 [`� Date: of 1-1 Staff: Receipt # tU6aLQH PARCEL INFORMATION /j© 07,YQQ - 0 -0 b -QS5 /' O Existing Zoning ed16 !l�e Tax Map and Parcel: Parcel Owner: �%�tGQ./ G!9 ��� t�i� 6ro u p hsso C t r°►41cfs Parcel Address: Iy%d /fiA16P- un 12• city t^Aarl07T�1/tIle—State y Zipo-&91/ (include suite or floor) QG� j Svc f /00 PRIMARY CONTACT.�Sd�`� --b Who should we call/write concerning this project � _ G (SWyI i'✓7� W Set City CkIo rloAcS it�tate VA Zip Address : Office Phone: t �S7"OW a Cell #t �$c39"7d . Fa.03-eo�(0SY'73V4-maiaSe tJ�'► APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business L �/j� / I ^�� (� �/� �K� �ey►Ga�� "(ii(�L�'1CtJC�TtJ( ikSCU� c Ve tt^ Business Name/Type: Previous Business on this sit __ kd"� t D � Ij Describe the proposed business including use, number of employees, n mber of shifts, available parking spaces, number of e e- eS vclhtcles, appd a,rrX� additional information that you can provide: d S-h,i— OYN O /12! trrlvm liG t°S� e- �to ►,�,� 0'� o+ti M t e-are , *This Clearance wil only • valid A titre parcel for which it is approved. If you change, intensify or move the use to a new local n, 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 certil} that the information provided is true and accurate t cst of my ledge. e read the conditions oi'approval, and I understand them, and that I will abide by them. 01 Printed e Signa 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, xl 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 Date Zoning Official Date Other Official Date k-ounty U! tHu-pe7unlIV Vv-a..... .,...... ..... .J ._"---'-.-------- 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126 Revised 11 /02/2015 Page 2 of 3 n Intake to complete the following: Reviewer to complete the following: j iYs uspn 1_1, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Square footage of Use: �4 �` N Permitted as: 4l C A/ Y ' Will re be food preparation? Under Section: (9 If so, give applicant a Health Department form. Zoning review can not begin until we receive approval from health 1 Supplementary regulations section: Dept. FAX DATE _ Circle the one that applies Is parcel on private well o 2U,is orate ?u Parking formula: NIf private well, provide Hnt form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE____ Required spaces: �y Y !O Circle the one that appli Items to be verified in the field: Is parcel on septic or b rc sewer. Y / N Will you be putting up a new sign of any kind`? If so, obtain proper Sign permit. Permit # Inspector : Date: Y;N Will there be any new construction or renovations? Notes: If so, obtain the proper Permit. Permit # ,ontng to comprew ine ,vuuwrrrr: _ Violations: Y l A I f si st: -- P offers: I N If' so, List: 3 Varia ce: Y,'' If so, isC SP's: If so"list: Clearances: SDP's /-51 Revised 11/ 1 /2015 Page 3 of 3 CERTIFICATION THAT NOTICE OF THE APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER Thisform must accompany zoning applications (Home Occupation, Zoning Clearance, Zoning Administrator Determinations or Appeals, Sign Permits, Building Permits) if the application is not the owner. 1 certify that notice of the application7�_15�tae-cL.,_FoL►'I r 6 M erl)cI he, o-t sfrt=.4:: [County application name aQJ number] sfa &)vYs was provided to /r b /C,L 4:W �e_r DrtS�16,rwp j i &,he owner of record of Tax Map [name(s) of the recordowners of ttthe7p�arcel and Parcel Numbers7960 60-0/—455 /7 t J by delivering a copy of the application in the rnanner identified below: liand 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 Meoli CaY& [Name of the record owner if the record owiler 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___--_.___-- to the following address: Date ,, J i p .. ala 7 e r � � /©D Char � SV a C � rvfi a � [address; written notice mailed to the owner at Re last kno-\ n a ress of the o��ner as sho" n on Al the current real estate tax assessment books or current real estate tax assessment records satisfies this requirement]. Signature of Applicant Print Applicant Name Date