HomeMy WebLinkAboutCLE201700147 Application 2017-07-26Application for Zoning Clearance
CLE
OFFICE USE ONLY
PLEASE RIL T cltk C' Date -
VI 1
.ReceiptStaff:
PARCELINFORMATION Gf'
Tax Map and Parcel:........ jam— �2"' % ;xisting Zoning 7 D�
tn
Pan-�t,.
Parcel Owner:--( c�� .f c� e-
_....................
............_.
Parcel Address: �1 �O W ` K L �., ; �rCity cl�w�,r�1���-il��tate _�rA ip��1
(include suite or boor)
J PRIMARY CONTACT
Who should we call/write concerning this project?
Address city r`0 V,� State , V Zipa -1
3 `(� — S \L %c—\< 5 K, ra c
Office Phone, (�� Cell # 11i ax #F E-mail 1n .cam
PLI. ANT INFORMATTON
Check any that apply: Change of ownership Change of uuse Change rof name Neap= business
Business Name/Type:
Previous Business on this site Cc-- S et r co ckr C3LCc.
Describe the proposed business including use, number of employees, number of shifts, available parking spaces number of
vehicles, and any additional inf rmation that you can provide-
. ........ .....
*This Clearance will only be valid on the parsei for which it is approved. if you cluinge, intensify or move the use to a new location, a neevZoning;
Clearance will '.he 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 the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
U-
rIS gzzatttre-- Printed _i_") Gem
APPROVAL rNFt TION
Approved as proposed [ ] Approved with conditions T[] Rented
Backflow prevention device and/or current test data needed for this site, Contact ACSA, 977-45117.
[ ] 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 _ mate r� l
Zoning Official mate..._._.._�.._........_............._
t
Other Official date
.......... ... ..... ................ ........................ ._...........
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5 32 Fax: (434) 972-4126
Revised I I/1/201.5 Page 2 of
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.
Wil there be food preparation?
If so, give applicant a health Department form.
Toning review can not begin until we receive approval from Health
Dept, FAX DATE ___
Circle the one that applies
Is parcel on private well - lic water �:
If private well, provide Ilea epar2rnent form.
Zoning review can not begin until we receive approval from Health
Dept, FAX DATE
Circle the one that applies -: -. _ —
Is parcel on septic o public ,sew ?
HN
Reviewer to complete the following:
Square footage of Use:
6 / N ^� {-
Permitted as: �� / m ?FTYt�G1,.Q,
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces:
Iterns o be verified in the field:
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit # 1 Inspector : Date:
Y Notes:
Witt there be any new construction or renovations? -------
If so, obtain the proper Permit.
Permit #
Violations:
Yt},Yl/
If so st:
I Proff rs:
;Ifs ist:
I
V riance:
Y/N
If so, List:
s:
�1N
If so, List:
__..........................
Clearances:
SDP's
1
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Revised I1/l/2415 Page 3 of 3
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 C- e— �e V- 0-� R,,e- the owner of record of Tax Map
[name(s) of the record owners of thelparcel]
and Parcel Number
manner identified below:
by delivering a copy of the application in the
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]
on
on
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 -- 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].
Signature of Applicant
Print Applicant Name
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