HomeMy WebLinkAboutCLE201800057 Application 2018-03-13Application for Zonin Clearance
CLE # ;n O ® O C_�_7
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # Date:
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: Q6512)17 --6p - ':)0 _., e) IC240 Existing Zoning
r, Parcel Owner: C, � t
Parcel Address:_ ` r� '-`-{{L�- '�(_N City _, t State V ;'� Zij
(include suite d floor)
PRIMARY CONTACT Who should we call/write concerning this � —kckrlu�J
project?
Address: City State (-AA P
Office Phone:C �VWZ Cell # 4� '-11 Fax # 414 1(_(_,j`L I E-mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: 12 cC•
Previous Business on this site\U t
Describe the proposed business including use, number of employees number of shifts, available parking space , number of,
vehicles, and any additional information that you can rovide: t
a va 1
.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 n r'" pernussroii fo-m e space indicated on this application. I also certify that the information provided
is true an accurate to the best of m cnowledge. I have read the con i s of approvaland I understand them, and that I will abide b them.
Signature mted kik ,t \��(.t1
AP RO AL INFORMATION
[ Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] 9,a6flow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, xl 17.
[ 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�Z-/�
n
Zoning Official Date 3/1 2�� b
Other Official Date
1,ounty or AiDemarle 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:
Is/
Is use i LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y�
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 o tha a ' s
Is parcel o ri a public water?
If private w , pro 'de Hea epartment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel o septic or public sewer?
Y /(p
Wilbe putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y /)
Will ere 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: 5S o 0
Y/N
Permitted as: U V V o tli obl `t' t l u i e puff S i►�
Under Section:
Supplementary regulations section:
Parking formula: 1
/QMP(O,� e -1te lie s}�;1)
Required spaces: + Z X 5 ' 13
Y/N
Ite e verified in the field:
Inspector Date:
Notes:
Vi ate s:
Y/N
If lst:
Pr
If
YTist:
Va e:
Y/N
If - st:
SPA
Y/N
If Est:
Clearances:
2ai3 13y
SDP's
Revised 11/1/2015 Page 3 of
dc-
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, Uk . ? ct ,
`[ ounty application name and number]
was provided WSW 1 + _ the owner of record of Tax Map
[name(s) of the cord ow ers oft parcel]
and Parcel Number 0�5C)O -bk(„A4� by delivering a copy of the application in the
manner identified below:
dHand delivering a copy of the application to r U.
[Name of the re ord owne 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 61 1, Uc")�
Date
0 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].
—7.._-/
Date