HomeMy WebLinkAboutCLE201500107 Application 2017-04-26Application for Zonin Clearance
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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
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