HomeMy WebLinkAboutCLE201700035 Application 2017-04-12Application for Zoning Clearance
CLE # ,l`]— 35
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # 0-10 Date: Z. S 11
Receipt # Staff:
PARCEL INFORMATION ;;��
Tax Map and Parcel: 0-1T Parcel 01 Rc_�r� OO000'7.7 Al Existing Zoning pa-rvle,rCi A �
Parcel Owner:t�i;nur eabb2oL farm L -C
Parcel Address:56Z Ackrvw?�,' Ste kw —City CkUr(o4esv/. fte State YA zip
(include suite or floor)
PRIMARY CONTACT
Who shouldwe call/write concerning this project? Lauren 00m 5
)p
Address : IOZ �h Oak Ave- City CAVr1Q4e15Ji Ile State Yt-t Zip ZZ9U1
Office Phone: Aq-+>51 Cell # �314-%0.1043 Fax # E-mail ( aurenc4lyi 5 525 rm,l.
APPLICANT INFORMATION
Check any that apply: Change of ownership _'�_ Change of use Change of name New business
Business Name/Type: 0C)oks ar\d C.rannie5 Ciennin U-C
Previous Business on this site (,(nkncm in. �mnk owned
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: + 't r
k ice. Z i tlAlole, 1.511S s Comraanq car-5
u t &k 5
*This Clearance will only be valid on the pare 1 for which it is approved. If you cha e, 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 my knowlei I have the conditions of approval, and I understand them, and that I will abide by them.
Signature Printedunen�l S
AP
OVAL INFORMATION
[V 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 Z -- ` -
Zoning Official
Other Official
Date � t Ucv
Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
OM
Revised 11/1/2015 Page 2 of 3
Intake to complete the following:
Y/N
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/N
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 public 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 or public sewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Reviewer to complete th.e f llowing:
Square footage of Use:
Edmitted as: Y_ �([Y�f(1 �j
Under Section: PO kt (- d. I 1
Supplementary regulations section:
Parking formula: I
Required spaces:
Y V N)
Itdmsfo be verified in the field:
Violations:
Y/N
If so, List:
Proffers:
Y/N
If so, List:
Variance:
Y/N
If so, List:
SP's:
Y/N
If so, List:
Clearances:
SDP's
Revised 11/1/2015 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, X r-�e. Zon�no, Ckarrance..
[County applica 'on name and number]
was provided to way e-r CAby--au. arm (-LC. the owner of record of Tax Map
[name(s) of the record o ners of the parcel]
and Parcel Number bjS0 (-)OOOC)O"I'7A"i by delivering a copy of the application in the
manner identified below:
Hand delivering a copy of the application to Lauren (-WVI S, (' o,('lv)I(Y(' r
[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 b2. log 12on
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
LLIArQ)n JTky i S
Print Applicant Name
UZ /03/2Ul-7
Date
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