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HomeMy WebLinkAboutCLE201700114 Application 2017-06-01Application for Zoning Clearance CLE # _ 0 � 0 U s FICE PLEASE REVIEW ALL 3 SHEETS COIF ck # uSE S2F ONLY `9 � Date: � %O Receipt # l Staff: PARCEL INFORMATION Tax Map and Parcel: 0' / l00-00-0"y- 0 I--1 O to Existing Zoning Parcel Owner: WJJ �kA�� et -op. '' 0 Pa reel Address: d � O Q6__O '�— Cit A- �Cd�- �� t �v,1L, state zipa}s��� (include suite or floor) PRIMARY CONTACT II Who should we call/write concerning this project? LA n�Q Address: R G"' t-j.C- l l ► i City 1G Office Phone: (_) Cell #J(b0-572io Fax # APPLICANT INFORMATION Chcck any that apply: Change of ownership Change of use Business Name/Type: Previous Business on this site 4- /U .1 �S ti i,P j State i P Zip 22gc t -) E-mail [(,�D Change of name New business 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 ormove the use Clearance will be required. to a new location, anew Zoning 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 the hest of my knowledge. i have read the conditions of approval. and I understand them, and that I will abide by them. Signature Printed LAn Q, C.'[-�— f1PPROVAL INFORMATION Approved as proposed [ ) Approved with conditions [ ] Denied [ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-451 1, 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 Official1 Date Other Official Date S�Z�h;'017 County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126 Revised 7/I /201 1 Page 2 of 3 CERTIFICATION THAT NOTICE OF THE APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER This form insist accompany zoning applications (Home Occupation, Zorrirrg Clearance, Zoning Administrator Determinations or Appeals, Sign Permits, Building Permits) if the application is not the owner. i certify that notice of the application, -Z0" ,, [County a ication name and number] was provided to �-�J-� � -QmOtw- -6 C- 3 t}e owner of record of Tas Map [name(s) of the record owners of the parcel] and Parcel Number O-1103- 00- W- (j 11 0 to 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] XM Date t/ 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 '5- %--1 " 1 Date to the following address: v [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]. r Signature of Applicant Print Applicant Narne 5-1-4 - t-) Date 3 ro