Loading...
HomeMy WebLinkAboutCLE201800031 Application 2018-02-16Application for Zoning Clearance °�" ,� CLE # _ in 4fgCApU` OFFICE USE ONLY PLEASE REVIEW ALL 3 SHEETS Check# / Date: Receipt # - Staff: PARCEL INFORMATION /� / Tax ,flap and Parcel: 07 gO �i — 06 �- 0 0 0 7-3 AL) Existing 'Zoning P617" 0 P i 9n r1 -r c;� m Parcel Owner:_ TQ Parcel Address: %UU /Ih6 Q 4 !t p -, cl City (l Q rlo i-o,( y t //��State VA zip;,)- M (include suite orboor) PRIMARY CONTACT r / /� , Wlio should we eail/write concernin/g this project? W e S (s d� j 7 d jt A J7 o C1 Address: %i �S r 1 n r'o c r e -t City n p _ State /r A- ZiPQ � Office Phone: (Lz) %)() Cell # 414 Fax # 1j/ J} E-mail L_ fcbJe 6 aa-/f , o n e Cc APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business t Business Name/Type: M / t � l Y �t �e p !1 / I t1 -t 4 - rs k1 Previous Business on this site S C' [' r' 9 d / Describe the proposed business including use, number of employees, number of shifts, availa le parking spaces, number of vehicles, and any additional information that you f an provide: t'rn p 'e ( c J na f , n ti �� J rl I 11 cr n r r^ d *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 1 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.Ihave read the conditions of approval, and I understand them, and that l will abide by them. Signature 4 d rn Printed Tt`, it t' c 'P p AP O AL INFORMATION Approved as proposed [ J Approved with conditions [ ) Denied [ ) 1jdcktlow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, xl 17. vfNo 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 v Date�S Zoning Official Date Z / 16 Other Official Date t,.ounry of ntnentarte Impartment of -community Development 401 INIclntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126 Revised 1 1 /02/2015 Page 2 of 3 x/ e c.- Intake to complete the following: Is Is u m LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Wil re 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 lie Ovate 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 Iss parcel on ub 'c sewer? septic o p Y 1` N Will you be putting up a new sign of any kind? If so, obtain proper Sign Penn Permit # Y/N Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # Zoning to complete the following: Reviewer to complete the following: Square footage of Use: 32 Y / N pi Permitted as: O11CQ� Under Section: r)_Q , 2. Supplementary regulations section: Parking formula: ' �206 Required spaces: Y N It o be verified in the field: Inspector : Date: Notes: C� r Violations: Y/N If so, List: 1oc;�Pc� Pro rs: YIN If ist: ----------- -- Variance: Y/N If so, List: s: N 0o,List: Clearances: c.LF 160g— IuR Scdtt(Q Ae SDP's zoc,?--10-7, Ss . L '2-op1 — Co, KL loop _ 125 Revised i 1/1/20I5 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] y��rxecr , cax c-}• was provided to _ I4 ictnn 2 i estae. 0Inar LotksJ' ILo LLC- the owner d ecord of Tax Map [name(s) of the r&Jord owners of the parcel] and Parcel Number 6 `] f?00 —00 '-00 - ©%jj�}- � 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 i - ivlailing 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 2 17 t to the following address: Date It" &-r-6t,6 Lrca Pik-e_. CarUsle 1pp, 1-7ot3 [address; written notic ailed 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]. Signature of Applicant Print Applicant Name 2171IY, Date ■ f a M I { [ (ƒ f E & m , a _ � \ \ m®»}) { �){]