HomeMy WebLinkAboutCLE201700056 Application 2017-03-01for Zoning
Application Zoning Clearance
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # Date:
Receipt # Staff:
PARCEL INFORMATION ` p
Tax Map and Parcel: '061 W✓0 - O 1-� 0 6 - 00400 Existing Zoning �M` et`GZeL l 01 h
1
Parcel Owner: yU `
Parcel Address: 1•2A-T 66 `0t t�(tlCta I I "1 �r City Ch-44D PkS' i )'e State V w7 Zip ZZ 9
(include suite or floor)
PRIMARY CONTACT SS
Who
should we call/write concerning this project? L•
Address : 3�7LI M a& J e. Mj � Zci City 64_6 M_e_� State V 17- zip_ Z
Office Phone: (W�) Z�j�-lP�Dy Cell # �8 Fax # E-mail r 5 V P../1 0,
Ci4r_i12n S O,i M Wll X A q_o —
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: �V �lS L.0 r' Z`
Previous Business on this site
Describe the proposed business including use, number of employees, n her of shifts, available parking spaces, number of
vehicles, and any additional information that you can provide:Y
*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 kno edge. I have read the conditions of approval, and Ij understand them, and that I will abide by them.
Signature e Printed 1—e_V
APPROVAL INFORMATION
�j 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 Date
Zoning Official Date
Other Official Date
Lounty of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
Revised 11/02/2015 Page 2 of 3
Intake to complete the following:
Y/N0
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /vtere
Will 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 o public water?
If private well, provide Hea epartmen orm.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic o pubbc sewer?
Y /�N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y /
Will ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: Y g/
0 / N
Permitted as: b 1
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces:
Y /
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
Y/O
If so, List:
Proffers:
Y/
If so, ist:
Variance:
If sc List:
SP's�:
if so,�L'ist:
Clearances:
SDP's
Revised I1/1/2015 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, —20AZ`- C� ecr a- J\C-
[County aMAcation name and number]
was provided to \`W\ -F-)AA KS4^ CIo:U-0_ the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number 0(00 &/b -O 1 - QQ- 0910DO by delivering a copy of the application in the
manner 'dentified below: -�� 2 t,
Hand delivering a copy of the application to 1 FS 1/+
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[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 Z—z3-ZP
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
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Print Applicant Name
'0 Z3 za 17
Date
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