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HomeMy WebLinkAboutCLE201800256 Application 2019-01-18SPPROVED by the Mbpmorle County Commun, ,•vent ner:artr1.1t r� �45-l9 Application for Zoning Clearance►r'`�" CLE # � r PLEASE REVIEW ALL 3 SHEETS OFFICE USE ONLY Check# Date: �Z Z Receipt # I Staff: PARCEL INFOR ATION Tax Map and Parcel: -r 01 "8GOGOOC-\ -`P� Existing Zoning r Parcel Owner: �" c �., �`•, *. ^ ,>�_�'✓ �' �� L—� �r�� , / Parcel Address:City I" L.c�TTF-S4�1L�-Estate V *+ Zip_ (include suite or floor) PRIMARY CONTACT Who should we call/write concerning this project? 7 Address: '-- City; ,r i v Ac State V� Zip.�wlIL Office Phone: 'i� Z �) r� '2 340 Cell # i 31 3 ?- Fax # E-maily v+W" ' APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business Business Name/Type: �:•-� d o� ,�,�: r Previous Business on this site Y Describe the proposed business including use, number of employees) number of shifts available parking spaces, numbe"f vehicles, and any additional information that you can provide: ;S,.T% a_ r �'"y-z "�r.c �:• + *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. 1 hereby certify that I Ste' or have t e er's permission to use the space indicated on this application. I also certify that the information provided is true and a urate the best a�f my k ledge. I have read the conditions of approval, and I understand th m, and that I will abide by them. Signature h` Printed lJ` �J�af 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, 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 �� C 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/i/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 /' N,,' 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 t at applies Is parcel on septic or public sewer? Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Y /; N1 Will there be 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: �� V N � ��.Jll,'^� ermitted as: L(racb1 �L ry.P(LA r Under Section: ail Supplementary regulations section: Parking formula: I Required spaces: I Y/N tems to be verified in the field: � 1)C.- V y/ysi b'31111:1 J I.LL►L`� IAt�t kPIA N (J(ur-- Inspector : Date: Notes: Vio ns: Y Ifs st: Proff �l If s! Vari ite: Y /0-, If so, List: SP's: Y // � If sb,—]`st: Clearances: SDP's C LE 2013 4517 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, [County application name and number] was provided to ie-L_2 the owner of record of Tax Map [name(s) of the record owners of the parcel] and Parcel Number (31; GOO Q O Q Q %l,C7 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 ar 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 17/ 2()b Dat 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 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]. t \ Z2 r t� Signature o'f�licant' a Pririt Applicant Name Date 0. 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