HomeMy WebLinkAboutCLE201800062 Application 2018-03-13Application for Zoning Clearan
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PLEASE REVIEW ALL 3 SHEETS Check Its , plLy
(./ Date:
�.I.INIPT,Dan.m..... Receipt# Staff:
Tax Map and Parcel: n i Existing yoning_
- nA O(1 1 3 I b ff
� Q S �,
Parcel Owner:__I Oct g V I 4 l G
Parcel Address: ti loQ() 1i (Z n Q� Citv
(Include suite or Odor) r laa riaEi{St i(.f stale UQ- zip 12 90(
Who should we call/write concerning this project? R A 41 t " [t
Address: 16 GIN14 1� t•( CltYrteA<rtcle b LAA �rT State yip )� 1/4D-7
Office Phone: (34 i,j]9-�405Ce1i# ova
Faxq_'75tL-v85( E-mail NAhiwult� [DUC(tjtJ.p7
that apply: V Change of ownership Change of use
Business Name/Type: _ M1 - Y ek, 4- ( Ce m m U sv e -1 t e to S r,[„A
Previous Business on this site -X-
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehlcles, and any additional information that you can provide: {rs L CI
F ewsntav,t-eS ['n �i iK
r �
'This Clearance will only be valid on the parcel for which it is approve
Clearance will be mqAred. d. if you change, intensity or move the use to a new location, a new Zoning
I hereby I'll
o have the owner's permission to use the space indicated on this application. I also certify that the information provided
is true anof my know gc. I have read the conditions ofapproval, and I understand [hero, anc that 1 will abide by them.
Cc/�SignatuPrinted Kl:-i..srvl A i t
AP➢'ROVAL 11MWORMATfON
[' Ap oved as proposed [ j Approved with conditions [ j Denied
[ ] ckflow preveotion device and/or current test data needed for this site. Contact ACSA, 977-4511, x117.
[ 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.
Building Official
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296.5832 Pax: (434) 9724126
Revised 11102/2015 Page 2 of 3
Intake to complete the following:
Y ( D
Is u e in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y Wi rik e 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 public wat
If private well, provide Heat Department 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 lic sewer.
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit # VVVjkd M" of r e> d
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
fec uxry a V'crvi�j
Zoning to com Dlete the followin :
Reviewer to complete the following:
�'i Square footage of Use: ill ` T4 Z'
Y/N ��S} mitted as: S>^ of
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces: �—
J
Y//N)
Ite s be verified in the field:
Inspector:
Date:
Notes:
nevi mner / nU 1mG
v�
Vio s:
Y N
Ifso—,List: 11
obo.fiFrl
Pr
Y ?ffN .
ist:
If Sy
Var' e:
Y/N
I ist:
SP's:
Y/N
If so, List:
15gZ- 56
ICIR-2, SO
Clearances:
LLE "Loi7- 1'%(�i MCOwl
SDP's
zuUs-- 3-7
Revised 11/1/2015 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
owner.
nrator Determinations or Appeals, Sign
rPermits, Building Permits) if the application is not the
owner.
I certify that notice of the application,
(-\1h�wParlt- n( number]
n [County application name ano nurnbcr)
was provided to 0. S �n t vt rf t mp G row p
�° ti r a ,( r J t__ the owner of record of Tax Map
[name(s 101 the record owners f me parcel]
and Parcel Number
manner identified below: by delivering a copy or the application in the
Hand delivering a copy of the application to
person; if the owner of record is an entity, y e I A th precord owner if the record owner is a
title or office for that entity) b, identify the reci lent of the record and the recipient's
on
Date
QMailing a copy of the application to
owner it the record owner i's —a
if the owner of record is an entity, identify he recipient rof the record and the recipient's title or
office for that entity)
on 3—`J—I$
Date to the following address:
[address; written notice mailed to the owner at the last known address of the owns as shown on
the current real estate tax assessment books or current aI a rate tax assessment records satisfies
this requirement].
Uv.'r
r ppncanl
Applicant Name
_3—%—I F
Date
SPRINT 105 Far mtrl.f ) iMOBILE
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