HomeMy WebLinkAboutCLE201800225 Application 2018-10-31i',PPROVED
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Application for Zoning Clearance
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OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS Check # I W [ Date: 2 t6-
Receipt It 1 Staff:
PARCEL INFORMATION _ A 1� ,
Tax Map and Parcel: Q 5 q' D 1- Q 1 - 0 D - 0 l5 0 0 Existing Zoning com mPf�Gix - fl `�
Parcel Owner: U VA
Parcel Address: L 13 C t,Fs R44� LAAe , `ST t C ty C io,, U& yt 4` (. State ►I !� Zip�2 q� 3
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project?
Address: I EoPW kfto (f I,, , stf City C0q'Q 111-L -SV ( State �� Zip229a3
Office Phone: 434 Zs5 0�� l Cell # Fax # �3 ��d �� Z� n 0� E-mail , (OA fWe-S C-11oA, j4 -
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APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: C l-to R S S l` I
Previous Business on this site MQ L¢—j • +(jjlAit + -
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicles, and any additional information that you can provide: tvN o e L 1Ay4g 4-rw ,.t-
w^�—,LY --c .0 Ar.nl 1 IC 1n c l
*ThislClearance w111 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 the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Si ature
gn 6 Printed � A �C S �L D
V l -F : Q a �f-34 a
APPROVAL INFORMATI
[ ] Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 9774511, 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 (cat' 3I / 1 8
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:
Y \�/
Is use m Li, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y
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 ublic water?
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 applies
Is parcel on septic public sewer?
Y/N
you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y
WilFiere 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:
�Y N
ermitted as: y
Ile i
Under Section: At, , (�
Supplementary regulations section:
Parking formula:
Required spaces:
Y/
Ite be verified in the field:
Inspector : Date:
Notes:
Viol ns:
Yif ist:
Pro
Y . N
If soli t:
Var'nfe:
Y
If s ist:
Spy
Y' N
If so, List:
Clearances:
aD i A .A t�n
SDP's
jell
113 ..
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igoo 7 wy ;kizD5 -
Revised 1 1/1/2015 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,
[County applicatiorf name and nu er]
was provided to UVA o oA d c. , U 0 the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number 1)5q C)Z —• 01 ^CD by delivering a copy of the application in the
manner identified below:
EZr Hand delivering a copy of the application to (V a, %
[Name of the r cord own 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] �, I w(
�2 20 a � ��a � • � �' IZe�'l E� �-!� ��
on 06hbet,l �b ✓ [!s�f 4;; } Gl S Z �?1�
Date
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].
A�) a&&2i, F�
S e
ature of Applicant
ET -
Print Applicant Name —r
/o/I2/1
Date
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e 18
EXHIBIT "A"
Attached to the Lease Agreement between the UVA Foundation and Clio Asset Management LLC
dated 2018
PREMISES FLOOR PLAN
1 Boars Head Place, Suite 220