HomeMy WebLinkAboutCLE201800152 Application 2018-08-28��S ►n e�,S �L� S �
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Application for Zoning Clearance
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CLE # -U 1 "1( Zr,-2
OFFICE li ONLY �--
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PLEASE REVIEW ALL 3 SHEETS
Check# Date: � -
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: U—Icfjc� -rV� ' Q0 — 0 *;�>'s Existing Zoning
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Parcel Owner: L�%CU✓ �lT� 1 Ce T CIV �.� `l— jo I&W—in u4 . t wnll
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Parcel Address:_ �c� �'vin (i/-} • toy- Cityl�y `t�ni I4 State � zip ��"/ ry ,
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(include suite or floor)
PRIMARY CONTACT �'
Who should we call/write concerning this project?e�(� �(�(t jl�Y
Address : Lg'—I i(ijr (✓� . . (tf1�' CityCf NA-Y i60f Su 1State V'P- Zip
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Office Phone: — '�Qkell # Fax # E-mail L\Gr U-)- 3
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APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: e ss
Previous Business on this site (�
Describe the proposed business including use, number of employees, number of shifts umber of
vehicles, and any additional information that you can provide: SQ�� — b cn M, e
*This Clearance will only be valid on the parcel for which it is approved. if you change, intensity or move the use to a new location, a new Zoning
Clearance will be required.
1 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 accurate to _ est of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signatur Printed SQ tom"
APPROVAL INFORMATIOt`v
[ ] Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention 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.
[ ] This site complies with the site plan as of this date.
Notes:
Building Official Date
Zoning Official Date L7
Other Official Date
k-uunty or Ainemarie impartment 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
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Intake to complete the following:
Y /(5)
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
WI I
If so, give applicant a Certified
Will there 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�thu
lic waterIf private well, provide Heaepartment 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 public sewer?
Y /(q
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y /67)
Will ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the followin :
Reviewer to complete the following:
Square footage of Use: y3 o
Y/N
Permitted as:
Under Section: 7 MA OVV I --19, T4c
Supplementary regulations section:
Parking formula:
IVW
Required spaces:
Y/Na
Items to be verified in the field:
Inspector : Date:
Notes:
Vio do s:
Y/N
If so, st:
offers:
/N
If so, List: t A
Z�
Va ance•
Y
If so, ist:
SP's-
if
If so, rst:
Clearances:
SDP's
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90—
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;LO 1 `S —oio`1`� 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
Administrator Determinations or Appeals, Sign Permits, Building Permits) if the application is not the
owner.
I certify that notice of the application, p Q u " SS q (--
[County a lication name and number]
was provided to YQY- . (Q �c t r U-L the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number 0'1900 - y5SD by delivering a copy of the application in the
manner identified below:
Hand 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 Lwyo1, O in Le A4, LL—C
[Name of the record owner if the record owher 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 � D . I to the following address:
Date
[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].
(- Signature of pplicant
SAL a�W1
Print Applicant Name
Date
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LUXOR OFFICE PARK
SCHEMATIC OF SUITE 1434-101
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