HomeMy WebLinkAboutCLE201700114 Application 2017-06-01Application for Zoning Clearance
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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. ''
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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
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