HomeMy WebLinkAboutCLE201700068 Application 2017-03-13 (2)Application for Zoning Clearance
CLE # LO
OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS
Check# t�i Date:
Receipt # 1(� L ZQ Staff:
PARCEL INFORMATION��//
Tax Map and Parcel: Existing Zoning
Parcel Owner: (JyF) Ci N U—C
Parcel Address:.3q6 co iGW( Cityy I (,testatey Zip
(include suite or floor) 0
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PRIMARY CONTACT
Who should we call/write concerning this project?
Address : �22 il'1 1 k� (�..- Fad-L--� Crty (� �Sf�C�27 e 1J� Zip 2796
Office Phone: (_ 'c3 � Cell #,5 Fax # E-mail 1y�1_�It�y
1�1F
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APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
12..�;.. o�� .r�.., rr.....,. �--1 � , , ! -�-.r , ,n rI I I o `� n o r /l
Previous Business on this Sif�
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, pumber of
vehicles, and any additional information that you can provide:
*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 t9Ahe best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature
Printed-
APPROVAL INFORMATION
M 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.
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
Revised 11/1/2015 Page 2 of
Intake to complete the following:
Y/N
Is use in LI, HI orPDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y`DN
Will there 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�water�`.
If private well, provide 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 septic o ubIir sewer
/ NT
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y /
Will `here be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to comDlete the followine:
Reviewer to complete the following:
Square footage of Use: /& 7
Perm N
Permitted as: e,5 b ��1 g�✓�
Under Section: 7
Supplementary regulations section:
Parking formula:
Required spaces: 11
Items to be verified in the field:
Inspector:
Notes:
Date:
Violations:
Y / (fl)
If so"riist:
Kroffers.
/ N
If so, List: M %
Variance:
Y/1)
If so, List:
SP's-
Y/i)
if so, List:
Clearances:
SDP's
Revised 11/1/2015 Page 3 of 3
CERTIFICATIONTHAT HAT 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,
[County placation name in-d number] C/�e,2-f" ce__
was provided to the owner of record of Tax Map
[name() of the ecord owners of the parcel]
and Parcel Number 35 �l� S/V),) 1 ✓ly i - y delivering a copy of the application in the
manner identified below: L V i l je V4 Zzql l
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
Data
V1 Mailing a copy of the application to
[Name of thk 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 - to the following address:
L:tat ;
[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].
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,
Signature of pplicant
5C4.�)- c-,-< \(-
Print Applicant Name
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