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HomeMy WebLinkAboutCLE201700129 Application 2017-06-05Application for Zoning Clearance�`9 CLE # N ICI - J `a F. PLEASE REVIEW ALL 3 SHEETS OFFICE USE ONLY Check # Date: Receipt # Staff: PARCEL INFORMATION D6�D _ cc _ 1 a- fO i o 1 Pc� �`+ � 1>-,L*Z �d '01(152�C2d � i Existing Zoning r�tQ Tax Map and Parcel: �� ( (�p , Parcel Owner: �r`y ✓t4�Gti Parcel Address: 6q I &erk✓nGi/_ City 4s✓) State (include suite or floor) PRIMARY CONTACT Who lG should we call/write concerning this project? /�'`ar� IG�l��y Address: G -, � � -r �d4 Rd, City l �J�i✓/G� /jc y '�te V /� Zip Office Phone: ( ) Cell #-V`1r�(�! ��gFax # E-mail �er_kln APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business ^ QD j /� Business Name/Type: Ire e kp �.c � C � �, f51/G ��d7Y�'Y. ��'C � rS GlC, Previous Business on this site ��©/11,�, nS� v� L1�,r�/ %i„r�yr,, Describe the proposed business including use, number of employees, umber of shifts, av ilable parking spaces, number of vehicles, and any additional information that you can provide: IX G : u ` i� G *This Clearance will only be valid on th parcel for which it is approved. If you change, intensify or move the use anew location, a new Zoning Clearance will be required. �� �c ,r5 ; g O 1� y�+; , i G� d S { I c� eG� Q) � � , 5, !permission I hereby certify th I own or have the owner's to use the space indicated on this application. I also certify that the information provided is true and accur o the be f my4�owl6dge. I have read the conditions of approval, and I understand them, I will abide by them. -,that ,aand Signature Printed�-�`— APPROVAL INFORMATION [ Approved as proposed [ ] Approved with conditions [ ] Denied [ ] Backilow 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 T 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 ,51►7-F. 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 Wi ere 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 o khe water?If private well, provide Hea tpartment form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that applies Is parcel on septic ?r pjLblic sewer? Yj/ N ill you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Y (NJ Wil ere 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: 2' 2 / ()/N nnn Permitted as: Under Section: 2- A. 2 Supplementary regulations section: Parking formula: �o o N4 Required spaces: .5 Y/N Items to be verified in the field: Inspector : Date: Notes: Violations: Y/6 If so, List: Proffers: Y/1Q If so, List: Vari nce: Y/3 If so, List: SP's-ll Y/O If so, List: Clearances: SDP's Revised 11/1/2015 Page 3 of 3 4/15/2017 Showlmage.ashx (1024768) 0/(??-1�- JDO$ OAS 2.1 COq 2'aoC 71.1 fY S`1 c�1 °i 04 � 1.3 sw D.4� 3ti,1 y= �f Rim MAk- t•..L NC http://gisweb.albemarle.org/GISWeb/Showlmage.ashx?t=s&f=S0000048\SO023539 1/1 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, was provided to [County application name and number] [name(s) of the record owners of the parcel] and Parcel Number manner identified below: Hand delivering a copy of the application to the owner of record of Tax Map 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 Date 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),�5 h 7 to the following address: Date [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]. A Print Applicant Name .s as - Date