HomeMy WebLinkAboutCLE201700121 Application 2017-05-23Application for Zoning Clearance
CLE#
OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS
Check # Date: S
Receipt # Staff:
PARCEL INFORMA ON //
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Tax Map and Parcel: tP Existing Zoning
Parcel Owner: �j y ij "i
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Parcel Address:-,-, Z 1 j L G �� t C Ll-&_ cityC. N a r <<H+�c v', l� State V [4 Zip 2 2 d1
(include suite or floor) Q2
PRIMARY CONTACT
Who
should nLe call/write c cerning this project?(Z.t/l° 5 �n�{-N�
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Address: y 04 wo i— M a •. !� ►► � City � �%0vJ'Lo ►-i'j v•+ State Vim- Zip
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Office Phone: (�'A C�11#`�3''t-�1(r2- Fax# E-mail
APPLICANT INFORMATION
Check any that apply; Cbange of ownerships Change of use Change of name New business
Business Name/Type: _ 0,s Z V Irt ec,Ltnn
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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:
'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 hereby certify that I own havc the owner's permission to use the space indicated on this application. I also certify that the information provided
is true and accu to to best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed
APPROVAL INFORMATION
Approved as proposed [ ) Approved with conditions [ ) Denied
[ ) Bacicflow 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 �T3),zl %
Zoning Official Date �rZ QZ2-17
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 9724126
Revised 11/I/2013 Page 2 of 3
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Intake to complete the following:
Y J
Is use'ld LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Will
(:re 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?
O / N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit. �7
Permit # � � 0 t t ` t4 0
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to com
Violatians:
Y/a
If so, List:
Variance:
Y / �G�
If so, ist:
Clearances:
the folIowint=:
Reviewer to complete the following:
Square footage of Use:
P /N
permitted as:.ZQ,M1,�
Under Section: 7
Supplementary regulations section:
Parking formula:
Required spaces:
Y N
Items to be verified in the field:
Inspector : Date:
Notes:
Y /(14
If so"
ist:
SP's:'
If so,
If o(ist:
SDP's
Revised 11/1/2015 Page 3 bf3
CERTIFICATION i`HA,r NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
TAis form must accompany zoning applications (Home Occupation, Zoning Clearance, Zoning
Administrator Determinations or Appeals, Sign Permits, Building pernu&) ifthe application is not the
owner.
I certify that notice of the application,
[County application name and number]
was provided to 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
om-
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].
cSignature of Applicant
Print Applicant Name
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