HomeMy WebLinkAboutCLE201700171 Application 2017-07-26Application for Zoning Clearance;"`
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OFFICE USE ONLY 1%v
PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Receipt # 60( Staff: � ti�7h�✓
PARCEL INFORMATION
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Tax Map and Parcel: / Existing Zoning Cam.<�•
Parcel Owner: W,) �✓�u S �`'y
Parcel Address: --Z-33 City C,A d)//,N i'll, State V`1'¢ Zip 2 d
(include suite or floo
PRIMARY CONTACT
Who
should we call/write concerning this project? I(����
�� aa Zdo 'I_ �
Address : ►mod �' Cityj C�(y►'[yVi� State U)#_.
Office Phone: Cell # # E-mail V! S !-
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name ew business
Business Name/Type: Iyir , Ut EC i r i-PS 1-6ori L i C �C�' Py1 iYtq andTVP y �
Previous Business on this site I C At )U f_,/—cep
Describe the proposed business including use, number of employees, number of shifts, available parking spacgs, number of
vehicles, and any additional information that you can provide: '7 lc/ -es —) CO2.lr (C 4cc'3 l Sr
*This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move the use to a new location, a new Zoning
Clearance will be required.
1 hereby certify that I own or have the owner's permission to use the space indicated on this application. 1 also certify that the information provided
is true and accur to the best knowledg I have read the conditions of approval, I understand them, and that I will abide by them.
Vfy
SignaturePrinted 641?�
APPROVAL INFO TION
Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow 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:
t
Building Official' Date
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
l)
Revised 11/02/2015 Page 2 of 3
Intake to complete the following:
17
Y/N
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
Will �erebe 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 or ublic water?
If private well, provide Health epa ment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic or p is sewer?
Y/N
Will you be putting up a new sign of any kind?
Sign permit.
I
If so, obtain proper
Reviewer to complete the following:
Square footage of Use:
Permitted as:
Under Section: Z3 , 2.
Supplementary regulations section:
Parking formula: A
Required spaces:
Y /
Items to be verified in the field:
1 1-rd I
Inspector:
Y/N
Will there be any new construction or renovations?
If so, obtain the roper Permit.
Permit #
Zoning to complete the following:
Notes:
Date:
Violations:
Y /b
If so, List:
Proffers:
Y /
If so, ist:
Variance:
Y / (9
If so, List:
P's:
N
If so, List:
g
Clearances:
SDP's
Revised 1 1/1/2015 Page 3 of 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,
[County application name and number]
�
was provided to �� d(�k�4�the owner of record of Tax Map
[name s) of the rec owners of the parcel]
and Parcel Number
manner identified below:
Hand delivering a copy of the application to
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
L,-�Mailing a copy of the application to
��✓ l� c`�f� � i�
[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 Jai ��� 2 U 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].
Sig 6rebfAppficant
Date