HomeMy WebLinkAboutCLE201700266 Application 2017-12-01Application for Zonin Clearance
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CLE #
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # Date:
Receipt # Staff:
PARCEL INFORMATION
1' C
Tax Map and Parcel: �,2k00-OO' 0GO PO Existing Zoning Il
Parcel Owner: ?\e-9S i\C-li
Parcel Address: fi kOLD Se V6 no\-k-- -TrCL% 1 City CV'1CL!( (ram (fe ,V; lle State —VA Zip aallo(
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? `— l
Address :_-q`(D City \kt State Zip t
Office Phone: (±: )oZ4a-;33`lI Cell# Fax# mailrr
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APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name __I/ New business
Business Name/Type: VA
Previous Business on this site I i
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: (4,rcLi ypl4a4eno
�nnpl� l sh f1 IDS PC,", ,iceV P_ K cleS,
*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 requir .
I hereby certify that I n o ha a the owner's permission to use the space indicated on this application. I also certify that the information provided
is true and accurate t c b st f my knowledge. I have read the conditions of approval, a d I understand them, and that I will abide by them.
Signature Printed 2,� DA c--!,
AP OVAL INFORMATION
[ Appr ved as proposed [ ] Approved with conditions [ ] Denied
[fl ow prevention device and/or current test data needed for this site. Contact ACSA, 977-451 1, x 117.
[' o 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 Date
Zoning Official Date !l 1 3 17
Other Official Date
i
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
Revised 1 1/02/2015 Page 2 of 3
all .(Qm
Intake to complete the following:
Y `' CN,
Is use in L1, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y/
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 o �water?If private well, provide Heatrm.
"Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies, ---
Is parcel on septic �u licb sewer?
Y
\r✓ill ou be putting up a new sign of any kind? If so, obtain proper
Sign permit. p
Permit-levyt SLQfh`tn%t i��m,�
Y /�N�
Wil ere be any new construction or renovations?
If so, obtain the proper Permit. y
Permit # �I�\1�— � kp fry vlt -e prIyr- I
Zonine to complete the following:
Reviewer to complete the (following:
Square footage of Use: kco
Y N UnsfeArj bSf RpprOv4� bt�
P€rmitted as: (fY1{n6a) Z (''ALINO
De�� �1a1�d� y/, �
Under Section:
Supplementary regulations section:
Parking formula: 1 I
�Z r &
Required spaces:
Y N
Ite o be verified in the field:
Inspector : Date:
Notes:
Vi ns:
Y / 'N
If s ist:
P
/ N
t 1 0, is:
I
Variance:
Y%NIf so, List:
( c, 3i-- (L
(20, List:
"L(? i i— I Gl
—
— m3 — 441
Clearances:
SDP's
"2..(1 t —1 ST
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I Dols IR 2
_
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407O --,L'; 3_—
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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
A �� the owner of record of Tax Map
[names of the reeoj owners of the pare
and Parcel Number 0(0( O 00 — 00 � ZD RDy delivering a copy of the application in the
manner identified below:
Hand delivering a copy of the application to LCJ�� t
[Name o the rec d owner if the recorEPowner 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 1 `— a % - A Oi'7
Date
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
Date
to the following address:
[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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Sig re of Applicant
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Print Applicant Name
I�(2�``�
Date
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ON MAY 2 2017 1 SURVEYED THE PROPERTY SHOWN ON THIS PLAT AND THAT THE TITLE
LINES 4b WALLS OF THE BUILI)IMARE SHOWN .
PP03EWY IS NOT IN A FfFINED loo YEAR
FLOW ZONE BUT IS LOCATEDMADEM w-mm
IN FLOW ZOW "X" AS
SHOWN ON CORMITY PANEL No. 51003C 02780.
SERVICE UTILITIES ARE LWDERW40MO. TUP 61-120W
C.S. 4049 PG, 67
I.S. SET
N.S. IRON NAIL SET
PP POWER POLE
N 57051" E
AS SHOWN ON
LEASE AGREEMENT
EXHOT
MARCH 23A, 2011
TOP 61-120J
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4' Lie, No. 2025
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CO"ONWIMTH
LAW AT\
SURWM�G', MC.
1484 GREENBRIER PLACE
CHARLOTTESVILLE VIRGINIA 22901
PH.- 434-973-0513
TMP 6i-120P
0.509 ACRES
PAVEMENT
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'2.15'
I STM r
TMP 61-12ou
BLOCK
CAP
11640
12.04'
SIGN
PP I
PAVEMENT
s .
.OtJT13 29
tf.e�-
PWSZCAL SUMAEi SHOWING
TMP 61-120P
1640 SEMINOLE TRAIL
ALBEMARLE COUNTY, VIMINIA
SCALE: 1' - 30' MAY 8, 2017