HomeMy WebLinkAboutCLE201700108 Application 2017-05-18Application for Zoning Clearance
64"
OFFICE USE ONLY
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PLEASE REVIEW ALL 3 SHEETS
Check # Date:
I
Receipt #/ Staff: J'
PARCEL INFORMATION
Tax Map and Parcel: 06 t M — n p-12 — 00145 Existing Zoning Pbrm C✓
Parcel Owner:
Parcel Address: /,3_% Ber<yylath>" Ur- city C�\argok.Q/y.O e-state VA
Zip��-9c�1
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? :it4 TAKH AB ALPtM
Address: I D.60,A 72-H Z- -Cityi'hr^"r��U6% .
- I Vle_ State �% %�
Zip 2 '�%l?(D
n
Office Phone: (� 223 714 l.6 Cell # Fax # E-mailcl/j'tCLtmbu5i�1¢ts5y
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name
New business
Business Name/Type: VTRuM F,3USi4E55.5 SYS-TEMS
Previous Business on this site
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: CDWSL LT i IJ4 F_—bia' Lea .
I
*This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move the use to anew location, anew 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 I understand them, and that I will abide by them.
Signature ` Printed J ! l 1 7-0 7
APPROVAL INFORMATION
-�v-j 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:
ZoningBuilding OfficiallW",I&I ME M_ Date.
WAN
Official Date
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
Co�r1
Revised I I/1/2015 Page 2 of
Intake to complete the following:
Y �el,l,
Is HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
(�)Y ill Will e 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 k�r pmb' water?
If private well, provide Heeaft-Dt artment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applie
Is parcel on septic or public sew ?
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 #
ZoninLy to complete the following:
Reviewer to complete the following:
Square footage of Use: `% _J
O/ N
Permitted as: d Q
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces:
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
1'��s
If t:
Pro , rs:
Y /
If so, List:
Variance:
Y /
If so, t:
SP's:
Y /
If so, ist:
Clearances:
SDP's
Revised l 1/1/2015 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,
[County application name and number]
was provided to .FAN E H • K A % the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number
manner identified below:
Hand delivering a copy of the application to
by delivering a copy of the application in the
[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
X' Mailing a copy of the application to •TA,4 E H . KAY [b ���K`�'"`�'r fir, C h�rl�l c�✓,tie VA Z�-9a1
[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:
CV A � c�
[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
) t J -T'^Icx � A --ny M
Print Applicant Name
S- I � 1 17
Date