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HomeMy WebLinkAboutCLE201700103 Application 2017-04-24Application for Zoning Clearance r r CLE # '�l �l - ` 1 �� OFFICE USE ONLY Date: ALL 3 SHEETS Check #' Staff: PLEASE REVIEWReceipt # /}. - �� C � WlA�2X�-KU PARCEL INFORMATI F C� o� Existing Zoning /� Tax Map and Parcel: !1 '' __r1 C-'w1en !'� . LLV _ Parcel Owner, Parcel Addres pgIlVLARY CONTACT Who should we call/write concerning his pro; ct? State �t�mp cde` i Address : FaxE-mailOffice Phone: .'1 # .r A U � ?j APPLICANT INFORMATION Chan a of use Check any that apply: Change of ownership g Business Name/Type: r vt Previous Business on this v Describe the proposed business including use, number of employees number o vehicles, and any addition }nform^��on �h�� you an p��te' e *This Clearance will only4 valid on the parcel for which it is approved. If you Change of jname Zip of - A or mo a the use to a new location, a new Zoning Clearance will be required. s on his n. I also certify I hereby certify that I o e best v my owner's p Ilia read the conditionsti ace use le sPnof�app o�altand IPnder�sotand hem, and that aI wilt thel bidelbyothem�`�ded is true and accurat o Y (Wmauske's Printed : Signature _ APPROVAL INFORMATION ]Approved with conditions Denied �<] Approved as proposed [ [ ] [ ] 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 detennination of compliance with the existing site plan. [ ] This site complies with the site plan as of this date. Notes: Date Building Official % Date/ Zoning Of ficial cial Other Official Date County 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/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 r? If private well, provide ealth Depai nt form. Zoning review can not begin we receive approval from Health Dept. FAX DATE Circle the one that appti Is parcel on septic�orpublie se er? 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 the following: Square footage of Use: �d C/ N Permitted as: Under Section: Supplementary regulations section: Parking formula: Require spaces: Y / Items to be verified in the field: Inspector: Notes: Date: Viola ' ns: Y/ If so, ist: Proffers. Y/((� If so",64: I Varia ce: Y/7l If so, List: SP's: Y/ If so, List: Clearances: SDP's Revised 11 /1 /2015 Page 3 of 3 CERTIFICATION THAT NIOTICE 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, . � U t r `� [.I� 1 [ 9unty ap li��th on�,ame an nu b, Ciln�r-` ui I S�c�V `was provided to owner of record of Tax Map [name(s) of the record owners of the parcel]I and Parcel Number r/"�� 9-by O V�� � � "� � '� 0 �/ 0 � ti,y delivering a copy of the application in the manner identified below: 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 �rV 1.( -/� ®�I 2116, ame 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 e tity] on— / to the following address: Date 94_0 4q0QC4 Oiar (o#e3v I , ((e U00 [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].