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HomeMy WebLinkAboutCLE201500107 Application 2017-04-26Application for Zonin Clearance n- PLEASE REVIEW ALL 3 SHEETS OFFICE USE ONLY Check # 01 e '--, O '� Date: Rcccipt # i o co c� LA PARCEL INFORMATION �h Tax Map and Parcel: 07 7040 —00 _00 - v 11 n a Existing ZoningU Parcel Owner:_ Earn es L-- L C Parcel Address: 06S- C;ypaDtiQ Xoac City C a(!O ff t.5 Vilk State VA. Zip");90a (include cite floor) PRIMARY CONTACT F L e Who should we call/write concerning this project? q U Address: 1 �10 r;yg SIXiA%S %Zparl City (4 har1ofkYUJ1,f State t/,4. zip Office Phone: y( M 977-$;& Cell# Fax#(/ 977-/ME-mail_,}�v!� �ht/�UC�M,7 APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business Business Name/Type::174 U—C. C.mp $ Previous Business on this site ,o h e-a n pa a h 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: Ft,jd,,A V;sual enW t i nSta ftw"onS 11/ g.4 e � Tlh-p_rg ar'e S';y camp q 1/ hcc�r$SS�Brk 3f�aceS Qgrl 6Ao 4 nFL; co Spa *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 herebv 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 kn wl ge. I have read the conditions of approval, and I understand them, and that I will abide by them. Signature Printed J� L��aci L+ v APPROVAL INFORMATION Approved as proposed [ ) Approved with conditions [ ] Denied [ ) Backflow prevention device and/or current test data needed for this site. Contact ACSA, 9774511, 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 Other Official Date Uounty of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126 Y. PJ eS Revised 7/1/2011 Page 2 of 3 Intake to complete the following: Y/N is use in L1, Hl or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y / _ Wil ere 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 wek�Vep�artment ater? If private well, provide form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that ap ' Is parcel on septic r public sewe . Y/N Will you be putting up a new sign of any kind? Sign permit. Permit # If so, obtain proper 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: S'/N Permitted as: o �r �a, f I ✓ �n Under Section. �( Supplementary regulations section: Parking formula: / I �) I -f �nJ dbo,nl 4b 0u U;& Required spaces: Y/01 Items to be verified in the field lilspectoY Notes: Date. Violations: Y/� so If , ist Proffers: Y/ la - If so.. ist Varia ce: Y / N If so, List: }�s; Y-zI N If so, List: Clearances: IOU SDP's ale ?) ; Revised 7/1/2011 Page 3 of 3 CERTIFICATION THAT NOTICE OF THE APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER 1rrs far�rr, rtrust accompany zoning applications (home Occupation, Zoning Clearattee, Zattitrg Administrator Determinations or Appeals, Sign Permits, Building Permits) if the application is not the owner. I certify that notice of the application, -ZorvA L 12 f [CouMy application name and number] was provided to tEarntS , UCC , the owner of record of Tax Map [name(s) of fhe record owners of the parcel] and Parcel Number 0% 7Qo -W-QQ -O// D9 by delivering a copy- of the application in the manner identified below: Hand deti-,�rering a capy Qf 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 Earn es, L L-C [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 15- to the following address: 130S G-OrTA C-iafe LAr Bate Charloff t,Sve lle., (14.,) lO( [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]. .00A61 Signature of Applicant Print Apppl1 t Name ,�-, dam/ - i s- Date J W q c� ` to� cv fa G a v"- N ,C z C �� JClr ai' ❑. fl. 0. r C1 �lA z, 0 1 IL i how W.-- Q�ja�o p �. x UJ u -owMW vOU�wU� 0M0 � gq+-}t q *t tPl " *t Oa In 1-0 M b C� 1� my cif jtqbemarle - GIS-Web - Property Information „`�,.�rs•""`" `••"`••'...� �_� - -_-- - r:4 a s• 5 4/15/2015 2:16 the AV company . 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