HomeMy WebLinkAboutCLE201800257 Application 2019-02-05Application fior
� Zoining
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1 OFFICE'. SE NLY
PLEASE REVIEW ALL 3 SHEETS Check # � _ Date:lf`Q
�. Receipt # 1 -- Staff: I
PARCEL INFOR
`l"ax Map and Parcel:
Parcel Owner:
Existing Zonirrg C j CQMP9c '
Parcel Address: i f�/...G1�" � e�/ iw _�� 1 (� __ C:it- _1 1_otFt S�i��� State ____ Zip Z? L
(include suite or floor)
PRIMARY CONTACT
Who should w•e call/%vr to concerning this project?- MIGt Aet- Syi&! 140
Address: SSS We,St f 02 ILD S& too City State ✓A Zip 22-9ot
Office Phone: (` 3_b ZTZ- 2ISq -Cell o 1rf7-32)-45•1° Fax # F-mail
APPLICANT INFORMATION ---------- ___.-__
Check any that apply: \\ Change of ownership Change of use Change of name Never business
Business Name/l'ype: t� t'j/ap3 yG.t.,,1 o C_0Li X_ (R "iA_ S PLLC
Previous Business on this site
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: _.-_QG►.�wtL._._r"�.• (_........_Ir•a�
f l t_.leanance %t ill only he valid on the parcel I'or which, it is approved. If yoo change., intell sifV or move the use to a new location_ a new Zoninzt
Cle._.t,nce will he required.
1 hereh% certify that 1 own or have the omier`s pennission to use the space indicated on this application. 1 illso certify that the iniormation provided
t5 trtic and accurate o the hest ofmy knowledge. I have read the conditions of'approval. and 1 understand them, and that I will abide by them.
Signature
'PROVAL INFORMATIONli
j Approved as proposed j ] Approved with conditions f J Denied
jBacl flocs prevention device and'or current test data needed floc this site. Contact ACSA, 977-4j 11. x 117,
f No physical site inspection has been done for this clearance_ Therefore, it is not a deterniination of cotnpliance with the existing
Sit e plan.
I ; 'I his site cornphes with the site plan as of this date.
Notes:
Zoning Official
Other- Official
Date , r
Date
(.'ounty of Albemarle Departrnent of (.:ornrnunity %yeti elopment
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
Revised 11"`1/2015 Page 2 of 3
intatte ro Complete the following:
O
Is use in LI, 1-1I or PDII' zoning? I f so, give applieattt a certified
Engineer's Report (CER) packet.
Wil ere be food preparation?
Ifso, give applicant a Health Department form.
Zoning review can not begin until we receive approval frorn Health
Dept, FAN DATE;
Circle the one that applies
Is parcel on private well or is water
it private well, provide Ilea th epartment forn.
Zoning review can not begin until we receive approval from Ilealth
Dept. FAX DATE
Circle the one that applies
Is parcel on septic <>r tbli;
Y i N
Will you be putting up a nctiv sign of any kind? If so, obtain proper
Sign pennit,
Permit #:
YiN,
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Reviewer to complete the following:
Square footage of Uise:
ertnitted as:
Under Section 0 b�
Supplementary regulations section
Parking fomiula:
1 Required spaces:
Itet o be verified in the field:
Inspector :---------- Date:
Notes:
Zoning to complete the following:
s: ---- Prof rs:—�_.-
Y \ !Y N
If`so, List: If so, List:
i -
i
1'a ri S P's —
Y;N
if st„ .'ist' ; if'sst:
i
l
1
Clearances -
SDP's
s
t �
:
Revised 11,11/201 Page 3 of 3
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 ()4,jky V-1 t r—or the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number
manner identified below:
by delivering a copy of the application in the
Nand delivering a copy of the application to DAuio AIIKA
[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].
,'Signaturetof Appliclht�
Print Applicant Name
/2-z(a `2w(ff
Date