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HomeMy WebLinkAboutCLE201700274 Application 2017-12-08Application for Zoning Clearance CLE # � (� 1 7 D6 �- 0— PLEASE REVIEW ALL 3 SHEETS OFFICErJE,QNLV/ Check # Date: 17 7 Receipt # Staff: PARCEL INFORMATION Tax Map and Parcel: 5 (o 6 -3 - 00 --(V —L709 () Existing Zoning F VS G Parcel Owner: �JeA� P{''` LA J Parcel Address:531p 1h<e WC,6612d City C oz--� State V'Zip (include suite or floor) PRIMARY CONTACT Who should we call/write concerning this project? Address : U 6 -� o`hkaaon( wat City (_ ro Q� State Office Phone: U b j��LKD-D Cell # Fax # E-mailco(y1r, r_(GJ W a ,1`Mq) ,CS) APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business Business Name/Type:`Ri Previous Business on this site SJ01 Ci usi(LC SSCL9'l pYy Y 1 c e_ S U I I Z C"T ► Lt'Ct l !1 i�rX Ci i i'fi�S I/ ?C.JU� !!? 7 ice, 41 i Describe the proposed business including use, number of employees, numbe of shifts, a .ailable parki g spaces number of vehicles, and an additional Igor anon that you can provide: I_ ' _ *This ClearaKre will only be valid on t e 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 to to the best my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them. Signature � Printed t ,(0-K APP VAL INFORMATION [ pprcved as proposed [ ] Approved with conditions [ ] Denied [ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, xl 17. [ o site inspection has been done for this Therefore, it is determination physical clearance. not a of compliance with the existing site plan. [ ] This site complies with the site plan as of this date. Notes: Building Official ����C �-�-__ 2' Date t' Zoning Official Date IL 7� Other Official Date County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126 Revised 11 /02/2015 Page 2 of 3 Intake to complete the following: Y Is LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y N Wi 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 r public water? If private well, provide Hea partment orm. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that ap Is parcel on septic r public sewer? Y/N Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit #yyoJla i Pq ul i ch S('rv'4e ��,yyvili' Y/N Will there be any new construction or renovations? If so, obtain the proper Permit. Permit# Wo,)id ilVte o+ wI l"Ac �P. Zoning to complete the following: Reviewer to complete the following: Square footage of Use: PN emitted as: d Under Section: 2S - 1 2() 0 - � 4. 2 Supplementary regulations section: Parking formula: �/ cmnlo�Pe t /cljPh� Required spaces: 2 It (/ N ) IteVdoo be verified in the field: Inspector: Date: Notes: Violations: Y/N If so, List: n�Da�ir� Proffers: Y/N If so, List: ZYh R Zd II ' $ Var . Yk% If so, List: SP's: YQ'i Ifst: Clearances: CLE Zak-- Sr. C40'11sfl( ri oyr� SDP's 7-o15— 21 2GQ1-- 171 Revised 11/l/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 �Q � - ,-bUSe— the owner of record of Tax Map [name(s) of the ecord owners of the parcel] and Parcel Number 05&7j 3 W -C,-0-- CCU by delivering a copy of the application in the manner identified below: QHand 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 1 Y- �ij 5 ""b [Name of the reco owner iT 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 %){'C �-2 0 J 7 to the following address: ate vA [address; written notice mailed to' he owne5- 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]. ignatur of Applicant Print Applicant Name 2 - 6 -,-;)C) 1 7 Date 12/6/2017 County of Albemarle - GIS-Web - Property Information Parcel ID: 056A3-00-00-00900 Parcel Assessment Data (CAMA) Last Updated On: 07/07/2017 Other Parcel Data Last Updated On: 12/03/2017 GIS/Mapping Data Last Updated On: 12/03/2017 r http://gisweb.al bemarle.org/GIS WEB/PropertyInfo.aspx?pin=056A3000000900