HomeMy WebLinkAboutCLE201800206 Approval - County 2018-10-01APPROVED
„ k--_--_;. (I ter"
Applicationrt Zonirrlrance
CLO
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE O J.Y
Check # Date: ZQ�
Receipt # IStaff: L
PARCEL INFORMATION
Tax Map and Parcel: Q n ^ Q - CJ3A J Existing Zoning _c j Liu&weyl
Parcel Owner:
Parcel Address: c -IS5 QYAJf. City Cr(b¢yI E3✓.��C�CStat,V1_(O,LYLL4 Zip 21901
(include suite or floor)
PRIMARY CONTACT Who S `_ �Cb�1 a(,�V4PV
should we call/write concerning this project? f
Address : ao�-('J r Llt'L� �1'1 City Cb241pt6&L)J .State Jt f0 LV)L*Ct Zip z22o)
Office Phone: 13f1 qW-4VS4 Cell 4460MAWFax # E-mail cg 1M i l )V/' ff
APPLICANT INFORMATION
Check any that applyChange of ownership ✓Change of use _ /Change of name New business
Business Name/Type: Pnwac/S'Qpptc 6)0cl `0L"Dn �::lC6 f "qa
Previous Business on this site C � r 1 �}�l/ _1 11e ��7� � C 1p" 1:J �,
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, num a o� f
vehicles, and any additional information that you can provide: • r T . — 1.
— IQ 0 01- (= 4- 10 - 5 5,& L 0 -- l 5
toningl"
*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
Clearance will be required.
I hereby certify that I own or ave the o ermission to use the space indicated on this application. I also certify that the information provided
is true and accurate to the t of m o edge. have read the conditions of approval, andI understand them, and that I will abide by them.
Signature Printed ' pk1 p11'bY, INt [ 1 Me; VI_
PR L INFORMATION
A�Backflow
[ roved as proposed [ ] Approved with conditions [ ] Denied
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 1
Other Official Date
County of Albemarle 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: Reviewer to complete the following:
Y / N Square footage of Use: �� v
Is use in LI, HI or PDIP zoning? If so, give applicant a C ' ied
Engineer's Report (CER) packet. Qlmitted
/ N
as:
Y/N
Will there be food preparation? Under Section:
If so, give applicant a Health Depa/weceive
orm.
Zoning review can not begin until approval from Health Supplementary regulations section
Dept. FAX DATE r... j !M A _ ,,„j
Circle the one that applies
Is parcel on private well o public water?
If private well, provide ealth Department form.
Zoning review can n egin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic or public sewer?
IY /N Nill you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Parking formula: 1
1140
6
Requ - spaces:
Y IteJN
s be verified in the field:
Inspector:
Notes:
Violations:
Y/N
If so, List:
Proffers:
Y/N
If so, List:
I ? — 14
Variance:
Y/N
If so, List:
SP's:
Y/N
If so, List:
Clearances:
a -
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, 1�6_ur,&45 RCO(L i db4 l otPt7-1�4cDrt v5a
[County application name and number]
was provided to j1ka,(K 4-QA gbkLZ IAJ i iai 6cs the owner of record of Tax Map
[name(s) of tlie record owners of the parcel]
and Parcel Number 045va - DO - CO - CA 3 Ad by delivering a copy of the application in the
manner identified below:
Q 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 Mg4Kd-Ct.,t Yq 1 wic C
[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]
Una , ii AA z2 L4
on l 2-R
Date
to the following address: of 4 a
F�fle
[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 Applicant
Print Applicant Name
,�-1 zqllq
Date
n
ZY
(D�
Me
n
v
cD'
n
EINF-1700,
-u
c
v
r-
<+
n
�,'
a:0
Q
o°
CD
(D
0-3
n
c�
0'
o
�
—
O
O_
W
O
O
N
V
CL
p
V
�I
O
(D
O
O
o
(n
O
O
(b
W
Cal
TPh
p
O
W
(n
�I
(n
�l
N
-n
T1
n
CD
3.
O
O
r-r
(D
V
O
0
W
co
O
Cn
TI
N
O
Cal
(n
C)
ti