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HomeMy WebLinkAboutCLE201700183 Application 2017-08-29Application for Zoning ClearanceTo CLE # Zy 1 J 0jQ ) , 3 OFFICE USE ONLY PLEASE REVIEW ALL 3 SHEETS Check # Date: - -2ci11 Receipt # Staff: \C.a.Azt?) r ,� ,; PARCEL INFORMATION Tax Map and Parcel- 06 RLO- 01- 00- poi 00 Existing Zoning, A�hwqv Com,,,c,Q,L, Parcel Owner: CC-ro(yr) /-1, Parcel Address: =? 10 0 S e-r•/<M a/Z -DA-r"✓e, City eh arJc)4XVj 1(r- State Vim- Zip '�;t 26 (include suite or floor) PRIMARY CONTACT Who should we call/write concerning this project? Z"oh n S , R)' dd i CX- Address: Ilaa-Q C-Acc- }•fie '3!✓d. zip;U3a o Office Phone: (MJ L/`17 • Soo 7 Cell # ?S9 ;3'ta JW Fax # %S1-SY7-71*E-mail John , I9.4cbU, _ APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name ✓ New business /� r 13nsiness Name/Type: fn0�p, ct� Lr M t S�� L� �,�j4 CQm4m17 n S#o� �, s f f, �'ft l Previous Business on this site 11 ed "S`-L -? W gA 9t22r%, INC- City ChCSGtp—eaGe, State VO,, Describe the proposed business including use, number of empl vehicles, and any additional information that you can provide: rl OL's -S:DO MPytda l-47r,day 1S'-',?o �lartKena number of shifts, available parking spaces, number of *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. 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. A I Signature APPROVAL INFORMATION yCj 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. [ j This site complies with the site plan as of this date. Building Official Zoning Official Other fficial Date Date Date County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126 Revised 11/1/2015 Page 2 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, Z Ong n t?� �,�� -h;J,l [County application name and number] was provided to if cyo6n FrQz, e,12 the owner of record of Tax Map [name(s)of the record owners of the parcel] and Marcel Number 04 / U.C) - 01-00- 0©30a 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] on Date ✓ Mailing a copy of the application to CCU'O lLsri Fyzi,z,, eo- [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 8 " 3 - 17 to the following address: Date _1a4a t4roLr s- Shee-L, CAarloAlcrolle., ✓a- 0?.�4o3 [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]. /Siture of Applicant J'c)hr, 9. l 4 dAj c l~ Print Applicant Name Date Intake to complete the following: Y/N Is use in LI, HI or PDIP zoning? Engineer's Report (CER) packet. Y/ON If so, give applicant a Certified Will there 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 If private well, provide 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 septic o public sewer? J/ N Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Will 4i Ju.j re, Reviewer to complete the following: Square footage of Use: -j ` I� I N permitted as:^"..l.UAII,' Under Section: 4 �%• ' Supplementary regulations section: Parking formula: / �V44 bar, "1 Required spaces: _ It i, 14) Ite -"Co be verified in the field: Inspector Date: Yj N Notes: Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # 01 i t GeGgt t y r e T Zoning to complete the following: Violations: �!N Proff Y/N� If so, List: �4L�AT`e Variace: SP's: YI(` Yl If so, List: If so, ist: Clearances: SDP's 3125 Revised 11/l/2015 Page 3 of 3 County of Albemarle - GIS-Web -Property Information Page 8 of 8 -TI ) i � f/j __j � 5"6 o Sq v. c, rl,- Foo+ 'T-,)+A 3 -'50 :S cL o c- a,- Fooq— F-,,,i i i5 � , d http://gisweb.albemarle.org/GISWeb/Propertylnfo.aspx 5/15/2017