HomeMy WebLinkAboutCLE201700116 Application 2017-05-23Application for Zoning Clearance
CLE # )-61 ? - 001 16
��>ROINIPf
OFFICE USE ONLY
/v %
PLEASE REVIEW ALL 3 SHEETS
Check # 1 33Date:
Receipt # Ze.2 Staff:
PARCEL INFORMATION
Tax Map and Parcel: ()t0 1 M VCC)1'3C' OI r—q Existing Zoning D C/
Parcel Owner: y ja yyc s-�-c uj a,,/, -•
Parcel Address: UUq �� -AK C rC l� City Chat/ 1U-�1 e SUJ 1-CState VA Zip ZZ 96,1
(include suite or floor)
PRIMARY CONTACT
Who K-P- 1 ,-f 6 ac h m c' VI
should we call/write concerning this project?
Address : DyS 1�t c c, �-t 3 S Dri U-Q, 1 UU City L1 VN'4Vla C C:Vvl State i✓` Zip 21 Q C-'1 C)
Office Phone: L 3 4IS I '3LM Cell # Fax #`f`f �-y5]' `7 y7q E-mail L.--10E i'11 Ll G
N ifM LE 1V D --T N i✓--1 . c- c NI
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name -.-'New business
Business Name/Type: NEM 01 hC
Previous Business on this site SL S 0 C+f 4 9 Ct c%j'�
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: MCt -4gcLgL t_:tvx 6, t G
avhpl-c- A?av KiyA1Q 104-4 Sh- 14-5 SL Sc, /` 3b
*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 or hav 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 of y oWledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature ( Printed P1 ''Pa U S I L4 I'm (w) , Le
APPROVAL IN ORMATION
Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, xl 17.
[ ] 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
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 ubbc w er?
If private well, provide Health epartment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that �pfublic
Is parcel on septicwe ?
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:
6/ N (�
Permitted as:
Under Section: %
Supplementary regulations section:
Parking formula: j J
roc^�/
Required spaces:
Y
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
Y 16
If so, List:
Proffers:
Y/
If son -list:
Variance:
Y/1
If so, ist:
SP's-
Y/—)
If so, List:
Clearances:
SDP's
Revised 11/1/2015 Page 3 of 3
Q
Scanned by CarnScanner
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, Ap Q l It a,-h OVA C ✓1(1-1 Ol Y CA V7 C
[County application name aild number]
was provided to 6I a w, 54- e W Q. + the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number 6 U 1 1-1 UL 0 13 C 0 f f- Lj by delivering a copy of the application in the
manner identified below:
Q 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
Q Mailing a copy of the application to bI cl ",CL S +-f W CC V- —
[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 q�L 1 7 to the following address:
Date
U9 &Yl�a r- C�,.�rG1-L, cho-r ic�-rSul slam, VA 22°e f
[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].
Z(� P- - � �
Signature Applicant
M_ LDC4UkA51 1(it V hVt Ccti'1
Print Applicant Name
1-1Z
Date