HomeMy WebLinkAboutCLE201700113 Application 2017-06-01N
Application for Zoning Clearance
CLE# dlat?- p 0/1 ?
OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS Check # S—
Receipt #
PARCEL INFORMATION
Tax Map and Parcel: dLf `-! - 00' oo • d t 000 Existing Zonin
Parcel Owner: re-r LL _ 'e, L
(:br
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Date: d �/
Staff: �J�b
Parcel Address: 3'f--1 S ;, —tr. City Ck, V; ((( State Vc—
(include suite or floor) zip -1�L! 1
PRIMARY CONTACT Who should we call/write concerning this project? C
Address : R L L. 12 A Cit 1G State V c
Y—_ Jvr� � Zip LZ9y1
Office Phone: (_) Cell # 9(.0-5-77,(, Fax h E-mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of natne New business
Business Name/Type:i=, c✓ k S S I r c
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, intensity or move the use to a new location, a new "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 est of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature 1 J�s C . S
Printed l'�—
APPROVAL INFORMATION
Approved as proposed [ J Approved with conditions [ ] Denied
( ] Qackflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, x 117.
[ ] 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 7/ 1 /201 1 Page 2 of 3
CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
This form must accompany zoning applications (Horne Occupation, Zoning Clearance, Zoning
A(lininistrator Determinations or Appeals, Sign Permits, Building Permits) if the application is not the
owner.
I certify that notice of the application, LID —, C' C , ►'-" r
[Count application name and number]
was provided to �C�y' rw�„`�...� (�L L, the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number CY-f G Q,-4- ()l) c»- O l oz)y by delivering a copy of the application in the
manner identified below:
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]
Oil
Date
Mailing a copy of the application to tJc7�
[Name of the record owner ifthe 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]
°n to the following address:
Date
�� 2 ►.��,� Q,- . CI,,,,., k - v;1 I , U� . 'Z Z C1 o j
[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
Print Applicant Name
IS-q-►"7
Date
S.