HomeMy WebLinkAboutCLE201900005 Application 2019-01-24APPROVED
by the Albemarle County
Community NvelnnmPnt PArartmPnt
Date 2
Application for ZoningClearance
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REVIEW ALL 3 SHEETS
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OFFICE USPLEASE
Check# /00 Date: — `.2Ql
Receipt # Staff:
PARCEL INFORMATION ,\ 11 �t t
Tax Map 6? 01 00 • 0V(Jx Pyl
• Existing Zoning
and Parcel: OU U_
Parcel Owner: '.10aV ii e D Ke_ M 1yxcA 0 ✓\ i DD S P C
T
Parcel Address: 15aV 8 loswramt Lail e City 0hid 6few. e- State VA Zipd/I
(include suite or floor)
PRIMARY CONTACT I /��
Who PC — e-(l
should we call/write concerning this project? VYl e. lG{ �Sto Ve r- /"I Ltd
Address : IS a , TnSu f an0 e_ Lyle_ City �e State Ufa Zip da`t 1/
Office Phone: H( 3y 713 'TTL1 `f Cell # 11W 806 9A.• Fax # y3`/ 775 (�dSa E-mail j2q#m 0Ver,-V1Plik5 n ql#ww,
APPLICANT INFORMATION
Check any that apply: t/Change of ownership Change of use Change of name New business
Business Name/Type: PKS Den��Sfrq IPLLC gener-cL( JeAt-5�rU
Previous Business on this site V JCl J n r D. R e'w A6, i n D D C PC -
Describe the proposed business including use, number of employees, number of shifts, available parking sp ces, number of
vehicles, and any additional information that you can provide: 11 em to e-es 9 C�a al �fi e
n0 o{R;e L vek,-des
*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 cur to he best of my kno le ge. I have read the conditions of approval, and Iunderrstand them, and that I will abide by them.
Signature K S ever —'"t Q
Printed ffid, 1
APPROVAL INFORMATION
[ Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-451 1, 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 �- e3 12
Zoning Official Date 1— 2 41-17
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
Celt-'7
Revised 11/l/2015 Page 2 of 3
Intake to complete the following:
Y /
Is us
LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
Willre 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 p
If private well, provide Health �e-partmenitorm.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic or p �c s
Y/N
Will 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 comDlete the following:
Reviewer.to complete the following:
Square footage of Use: 2,50 0
Y/ N
Permitted as: r ✓>9� �SS�O� CIG�S (dnt` g ( )
Under Section: 20-`��1CZ) ' J 7,'✓,2, t (2)_
Supplementary regulations section:
Parking formula: '/'7 $ toot
Required spaces: C
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
/ If sst:
Pro
If so"List:
Var' e.
Y N
If s , ist:
SP's:
Y /�
If so, List:
Clearances:
SDP's p
G ` f Z5r
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,
was provided to
[County application name and number]
[name(s) of the record owners of the parcel]
and Parcel Number
manner identified below:
Hand delivering a copy of the application to
the owner of record of Tax Map
by delivering a copy of the application in the
[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
[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 t
Pa iM f (a S�bv-e f- ICI f i a S
Print Applicant Name
DI IC)�-1 aol
Date
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