HomeMy WebLinkAboutCLE201700130 Application 2017-06-06Application for ZoningClearance "
CLE 1- OFFICE UISE ONLY
PLEASE REVIEW ALL 3 SHEETSCheck # Date:
Receipt Staff:
EL INFORMATION
Tax Map and Parcel:............. Q U "�J(,— Q �yAo Existing Zoning_ - As L
Parcel Owner:.....�5._��/L� .........._,... (� C d 1
Parcel Addresa:_.].f f r �i�� c~rR City State 11A Zip 2�Q
(include suite or floor)
PRIMARY CO IyACT
Who should Nve caWwrite concerning this project:
i
Arlcirtss :�!��t/.....Qel/i� _ t:,itrf//LLE State %. p
Office Phone: (90) —Wk .SQ3 Cell 4 Fox 9 -E-mail
AEI'LICA. `I' INFORMATION
Check any that apply: Change of ownership Change of use �Change of name e New business
Rosiness Name/Type:
Previous Business on this site _ _ 5-Pl11vC1 M, F ___
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 Cleararce will only be valid on the, parcel for which it is approved. If you change, intensify or move the use to anew location, a new —Zoning
Clearance will he required.
I hereby certify that I own or have the owner's permission to use the space indicated an this application. I also certify that the information provided
is true and accurate t e est of my knowledge. I have read the conditions of approval, and I understand these, and that I will abide by them.
Signature Printed
I;P OV?AI., IIf IR INIA,
[ICJ Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backilow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, x117.
[ ] 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` hate Al . . .....
/
Zoning Official ...................
Dther Official Date;
Uounty ol Albemarle Department of Community Development
441 McIntire Road Charlottesville, VA 22902 Voice: (434) 246-511 2 Fax, (434) 972-4126
Revised 11/l/2015 Page 2 of
Intake to complete the follo °i -
Y //5i
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y li�Wii be food preparation?
If so, give applicant a Health Department form.
Zoning review can not begin until we receive: approval fxom Health
Dept. FAX DATE ._.....
Circle the one that applies
Is parcel on private wel tau le ter?
If private well, provide alth De rnent form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that a
Is parcel on septic o u . e r?
YIN
Will you be putting up a new sign of any kind?
Sign permit.
Permit #
If so, obtain proper 11
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to connglete the following:
Reviewer to complete the following:
Square footage of Use: / % -)- V
(9/ N
Permitted as: 0£'k►_«-
Under Section. 17 '2 2_I
Supplementary regulations section:
Parking formula: y,
Required spaces: �}
v
Items to be verified in the field:
Inspector:___. hate.
Notes:
__....._........._....................................-
V* Ia iozas:
Y/
If so, ist.
P offers:
/N
If so, List:
�AA 3--0
V lance:
IN
If so, List: 93 -�
SP's:
6/N
If so, List:
6� 3i
..........
Clearances:
SDP's
2
Revised I l/l/2015 Page 3 bf 3
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,
the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number --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)
Mailing a copy of the application to fi &2
[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 the following address;
I V1 5 ozo C-azzak"s iw 5TF 300 W,5WA 1,1A ;�/.2_ ,
[address; written notice mailed to the owner at the last known address oft e owner as shown on
the current real estate tax assessment books or current real estate tax assessment records satisfies
this requirement].
Sign rp, o �Applicant
............. . ...
i�r0 Applicant Name
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