HomeMy WebLinkAboutCLE201700080 Application 2017-03-24Application for Zoning Clearance
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OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS
Check# ��Sti Date: 01
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Receipt # Staff: �'
PARCEL INFORMATION n( (�
Tax Map Parcel: 06I "� 0 v � 1 ` 06' 00600 �� I
and Existing Zoning
Parcel Owner: Fr1z,A t i --4/ IA'2A
Parcel Address: q S(o-) Q V�� City CL J �' e Cvil Q State �� Zip
(include su' e r floor)
PRIMARY CONTACT {�
Who -
should we call/write concerning this project? QtZ r � N, •.o r;
Address : ` 1 C) us #) 21 � cityCLIZIw1k State �tA Zip 2
Office Phone: 2 Z56 Cell # Fax # E-mail
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APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: � "I1 Q f� tAnLCo��jne\C S�,oQ
Previous Business on this site km o oyl L,
Describe the proposed business including use, n ber of employees, number of shifts, available parking spaces, number of
vehicles, and any additional information that your provide: Z E� is (dot
,can
*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 knowledge. I have read the conditions of approval, and understand theme, and that I will abide by them.
II
Signature ytl Printed NrnU_.;
PPROVAL INFORMATION
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 y 2-`f� /Z,�
Other Official d Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
Revised I1/1/2015 Page 2 of 3
Intake to complete the following:
Is /
Is use n LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
Y r
If so, give applicant a Certified
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 publiA�®rm.
If private well, provide Hearl�e
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies_ __._.
Is parcel on septic or bliss 4 r?
Yam)/ N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y /JN
Will e be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zonis to complete the following:
Reviewer to complete the following:
Square footage of Use: / Z (D
P" tGlf l
P / N �-.
ermitted as: w /�
Under Section:
Supplementary regulations section:
Parking formula: ' I
Required spaces:
Items o be verified in the field:
Inspector : Date:
Notes:
Vi atio :
Y /
If so, List:
Pr s
Y N,
If so, Lis .
Variance:
Y/s
If so, s :
S s:
Y/
If so, ' t:
Clearances:
SDP's
Revised 11/l/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, —7,,
[County)
pplication name and number]
was provided to Z IA]e „tl hEa the owner of record of Tax Map
[name(s) of the record owners of the parcel
and Parcel Number (Xi o j -- m r oc -mQ (L^by delivering a copy of the application in the
manner identified below:
r„C 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
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].
�',e - N� -
Print Applicant Name
C)3/i6/1
Date