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HomeMy WebLinkAboutCLE201800230 Application 2018-11-20Application for Zo nin Clearance A '1RGIv�P OFFICE USE ONLY PLEASE REVIEW ALL 3 SHEETS Check # T.113 Date: ( j Receipt # 1 v Staff: ' PARCEL INFORMATION Tax Map and Parcel: 0_.8 0 o p ©pot 1 LSO Existing Zoning WQ L;2%e Io Parcel Owner: L..aJ LLC— Parcel Address: ��,�ttU RA �'�r 8-1 City C VlccNo %%�� State V4 Zip 229/ (include suite or floor) PRIMARY CONTACT Who should we call/write concerning this project? Address: / 000 Ge y �.%✓' `G Ll.1U6 City cAae 174rsVi State Zip :2.29 Office Phone: Cell # Fax # E-mail T k✓1'1ZA tr f6,py/t, Gory, APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name _XNew business Business Name/Type: 5A6KCLV-Jb l.�, l ,�n'p !t/^G..{f f'i,.t ct„i�'py,)r� [t,a,4 �. i'>✓lrti �rtia Previous Business on this site ! 1R95sa, 1 ra r�ti � r 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: p—�1 n / P r►,. /ove,C k; Ct n6`&Jft!LC"d 4 k LA 0/ 'k Od Wrr s; r *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 the best of my knowled I have read the conditions of approval, and I understand them, and that I will abide by them. Signature Printed TL'Y�Y W 1"i/'a,# APPROVAL INFORMATION [ ] Approved as proposed [ ] Approved with conditions [ ] Denied [ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, x 117. [ ] 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 0 Other Official Date %-uunty of AiDemarie department of uommunity Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126 Revised 11/02/2015 Page 2 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,-20WItt& C1_4?X)�A N,- [County application name and number] was provided to A i � iqx a- Ltf La,,t c LC- the owner of record of Tax Map [name(s) of the record owners of the parcel] and Parcel Number 07,Q4200c7opo I ( ©C) by delivering a copy of the application in the manner identified below: Hand delivering a copy of the application to 61 6,k.&,a 44C [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_ JO �L411 Y Date/ 0 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]. Signature of Applicant Terr�w �� h/, YC 'a - ' Print Applicant Name Z v �G Z Date Intake to complete the following: Y/© Is use in LI, HI or PDIP zoning? Engineer's Report (CER) packet. Y /© 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 public 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 o public sewer? Y/NO Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Y /® Will there 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: 6 -70 S . F ]()/ N permitted as: Under Section: '0 Supplementary regulations section: vl16 - Parking formula: Required spaces: Y / Items o be verified in the field: Inspector : Date: Notes: Violations: Y N If ist: Proffers: Y �` If sO'71-ist: Var�e: Y0 If so, ist: SP's: If S YPist: Clearances: SDP's Revised 11/1/2015 Page 3 of 3 EXHIBIT A 198 SPOTNAP ROAD SUITE B-1 670 SQ. FT Lease Date October 15, 2018 Shenandoah Fine Art