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HomeMy WebLinkAboutCLE201800197 Approval - County 2018-09-28APPROVED by the Albemarle County Community Development Department Application fo oning Clearance�A CLE # 0 (% 7 �lRGIN�P PLEASE REVIEW OFFICE USIA ONI V ; i C' 6 ALL 3 SHEETS Check # Date: t Receipt # Staff:' PARCEL INFO ON Tax Map and Parcel: Existing Zoning_gt (.1 h in a o C o M WItq-C; Parcel Owner:- ►'� 1- Z V R sue: i__ ��" Parcel Address: CityC r lGIidOTreS'�� �� State Zip Z C r� (int0e, , ite or floor) i.l PRIMARY CONTACT / 1 Who should we call/write concerning this project? �']7"i(i�t'(A E= Address _VV4 City CbY..r'InAL-&Vi Ne- State `f A Zip ZZgo � v Office Phone: Cell #(L 3�"��( -. 1 # E-mail �' P.fS 1.55 11cl�U APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business Business Name/Type: _ Tfl ce,, S pp ;; Previous Business on this site IV C) n�- Describe the proposed business including use, number of employeC/es, number of shifts, available parking spaces, number of vehicles, and any additional information that you can provide: D ' ?�� i &4'{ U_-C .rL enI PQiYt+n � S *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 owner's permission to use the space indicated on this application. I also certify that the information provided is true and accurate to knowledge. 1_4awwread the conditions of approval, and I understand them, and that I will abide by them. Signature Printed Cal cY APPV IftMAIATJON [ pproved 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 Other Official Date wunry of arinemarie uepartment of Uommunity Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126 1%1 ,© rA Revised 11/02/2015 Page 2 of 3 Intake to complete the following: Y/N Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y /(lz) Wil 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 or ublic� 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 applied _ Is parcel on septic or ublic sewer? VN mill you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Y / WillPtere be any new construction or renovations? If so, obtain the proper Permit. Permit # Zonine to comDlete the following: Reviewer to complete the following: Square footage of Use:(00o Tl/N 4t,�rmitted as: Under Section: t! b Supplementary regulations section: Parking formula: Required spaces: Y/N Items to be verified in the field: Inspector Notes: Date: Violations: Y/N If so, List: Proffers: Y/N If so, List: Variance: Y/N If so, List: SP's: Y/N If so, List: Clearances: SDP's 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, 0 n I o Uea(—avic-c [Coup pplication name and number] ._— _ was provided to ��t1$; P C Un jywes qr the owner f r�f Tax Map [name(s) of the record owners of the parcel] and Parcel Number(.)( =.-oo ( 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 koaAn5i a2. C S} LLC C/0 T-,Au ft6(- r-- ayiet , en [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 forthatentity] / on �-q I [ Aft to the following address: Date [address; written no icemailed 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]. (9la��' Date Noy �,�II Fc��lb;vqj