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HomeMy WebLinkAboutCLE201700210 Action Letter 2017-09-12Application for Zonin C earance As CLE # OFFICE US Y PLEASE REVIEW ALL 3 SHEETS Check# Date: Staff: Receipt # PARCEL INFORMATION p Tax Map and Parcel: 57bgF'F11Ft Existing Zoning_ Parcel Owner: tGU N �� 1✓0 (7-P, L ri-- _ O`t� S Ko►4 D 7 �SVCitY V tate VA- Zip ?t Parcel Address: _ (include suite or floor) PRIMARY CONTACT J tiYUtlts" Who should we call/write. concerning this project? f!: � fm�c( state Zip ;+E--13ol Ci"ylr4 Address:�y6ST iVA- "cZf-fta„XG�L?CellOfcePhone��f' x�! APPLICANT INFORIffATIM_ Check any that apply; Change of ownershipj Change of use Change of name New business Business Nameffype: Ab,4 r 7 r ` ip5� UAp 7 r P6C1 Previous Business on this site l — Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of 6"-t p1^ FPS vehicles, and any additional information that you can provide; c5- *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 1 o a the owners permission to use the space indicated on this application. 1 also certify that the information provided is We and accurate to es f my knowledge. I have read the conditions of approval, understand them, and that I will abide by thetas. �and dII 6 -E6- Signature _-- Printed__ L I O TIONCas proposed [ J Approved with conditions ( ] Denied �Appr,�,d [ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, x117. [ J 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. Notes: Building Official Date Zoning Official Date Other Official ____ _ Date County of Atnemarie impartment or s,ommunny vvvrwi mut 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126 Revised I I/l/2015 Page 2 of 3 Intake to complete the following: is use in LI, HI or PDIP zoning? if so, give applicant a Certified Engineer's Report (CER) packet. Y 1 T�] Will 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 or p blic wat . If private well, provide Health ent 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 public sewer? Y/N Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Y/N WiI] there be any new construction or renovations? If so, obtain the proper Permit. Permit # Reviewer to complete the following: Square footage of Use: I� ► ��1 Z Y N r ermittedas: /. bee —C1�. � prAC�''.►Y�--=_ - Under Section; ML P1jAt: e-- Supplementary regulations section: Parking formula 4,7Vjco0 Required spaces: S' Y -N-Y-- IternK be verified in the field: Inspector Date: Notes., olations: Y N so, List: ����� fern: N so, List: ZMFi 0-7 _ Q�- riance: Y ( N 2�:� so, List: SP, Y If' ist; Clearances; SDP's Revised 11/1/2015 Page 3 bf 3 CERTIFICATION 1 A l.' NOTICE OF THE APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER This form must accompany zoning applications (Home Occupation, Zoning Clearance, Zonkig Administrator Determinations or Appeals, Sign Permits, Building Permits) if the application is not the Owner. I certify that notice of the application, /VP AYL 7'10 1\11WG (�, [County application name and number) was provided to� �r /r! ��7 /` m/ lz v;, l ' I°C owner of record of Tax Map [name(s) of the record Hers of the parcel) 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 Date :/ Mailing a copy of the application to 6 lja6t T kEl ' [Name of the record owner if the ecord owner is a person; if the owner of record is an entity, identify the recipient of the record and the recipient's title or off[ce for t entlty) on g 3 I 1 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]. 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