HomeMy WebLinkAboutCLE201600250 Application 2017-03-06Application for Zoning Clearance�`�4
CLE # AD1(p' 95D
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ,�LYONLY
Check # Date: 2
Receipt # J-Q, Staff.•
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PARCEL INFORMATION�t`�� /n�
Tax Map and Parcel: [Y Y�l 0 " V J ~ " 6 f Msting ZoningJvl
Parcel Owner:Al e tYgm le Flixce EAAP t LQ.,,
Parcel Address: 12.21 Mo lyl Citytolum U Cl State 7e, zip ig`
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(it�cyyde sp' floor)
1
PRIMARY CONTAC�TTCG.
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Who should we call/write concerning this project? I Yl/l t
Address E- 2 tri to- I/ I I le J-'i fe,/-4 City I tr State / `' t-D Zipal 771
Office Phone:( LO '%p - i" cell#{.�jlG" `� 0 7-RIFay # E-mail'-iifi� ` +1�+ . Cowl
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name L_New business
BusinessName/Type: 1c, .
Previous Business on this site
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicles, and any additional information that you can provide: 'd1i lx ✓' z?t 4
�'r f'� �(" -c �''yi7 '7 i ; L'a•�1 � ' t l y V .' L+ r i =r
'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;ownees p rmission to use the space indicated on this application. I also certify that the information provided
is
true and accurate to the of my n c e. I have read the conditions of approval, and 1 understand them, and that I will abide by them.
Signature--'— Printcd.L— ,-�/,,
J f
APP VAC INFORMATION
[ Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, x 117,
[ ] 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
T
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 9724126
Revised 11,,02/2015 Page 2 of 3
Intake to complete the following:
Y N%
Is u n LI, HI or PDIP zoning? Ifso, give applicant a Certified
Engineer's Report (CER) packet.
Reviewer to complete the following:
Square footage of Use:
Y / N .,�_r s 11 _ A
'r-ermn[ea as: \-A lh k t ny
�ill
there be food preparation? Under Section:
If so, give applicant a Health Department form.
Zoning review can not begin gntil we receive approval from Health Supplementary regulations section:�---
Dept. FAX DATE
Circle the one that applies Parking formula: �j„ Lf �J
1s parcel on private well or p lic "at
If private well, provide Health men' form.
Zoning review can not begin until we receive approval from Health Required spaces:
Dept. FAX DATE 6 0)
Y f N
Circle the one that Ite be verified in the field:
Is parcel on septic public sewer?
YiN
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit # Inspector • Date:
�Y1 N Notes:
'Will there be any new construction or renovations?
Ifso, obtain the proper Permit.
Permit # � to
Zoning to comnlete the follmvinu:
Violations:
Y?N
Ifso, List:
fTers:
Y N
so, List:
o
Variance:
Y?N
Ifso, List:
� ,,
SPA
YiN�
Ifso, isC
Clearances:
SDP's
Revised 1 If1/2015 Page 3 of
CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
This form inust accompany zoning applications (Hoare Occupation, Zoning Clearance, Zoning
Administrator Determinations or Appeals, Sign Perrrrits, Building Permits) if the application is not the
owner.
I certify that notice of the application,
[County application name and number]
was provided to the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number
manner identified below:
QHand delivering a copy of the application to
by delivering a copy of the application in the
[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
CEZ Mailing a copy of the application to 1314 emaLrl-e P1jda Sj"P ' LLO--
[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:
12'Ll "ekv" eo l imbi A , Se- 2l 24 1
[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].
Date