HomeMy WebLinkAboutCLE201900025 Action Letter 2019-02-22Application for Zoning Clearance
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CLE # , Ql�' AG_
.. A'n'.
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OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS
Check # LA19 Date: I
Receipt # CG Staff:
PARCEL INFORMAJ�JON j nn
-OF( ( Existing Zoning O'" `
Tax Map and Parcel: �, �dr
Parcel Owner: r 0 Acre rT—E&s L C_4__C
ParcelAddress:,321-- t'Ouin 4 L #,ez VJ& State Zip 2zYV,�
,_Ie_ —city �C4,,L
(include suite or floor)
PRIMARY CONTACT
7571 eVz-"t
Who should we call/write concerning this project?
Address: 2- ZU 4/194 / L c/7, pie j LgA e City Z -z^ G-oltr-t c(.rState l% !' Zip 22;,YZ
Office Phone: �1( �Y) � J S -ex-io Cell # '(-91S--OS-90 Fax # y34/Z�ffi,2q.0 E-mail S„/1 � ufk�J Cast
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: / `2C1147 yr`i< < 7 JC/yrcel LLyC
/' �ll`t,.% f{'",^-►� . �� �/ I.-f nCd Cl JI Gu � cold
Previous Business on this site
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
74
vehicles, and any additional information that ou can p vide: . oc� !K4t - . S e-:�
Q - cji,�1
*This Cl arance 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 knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed C_�,e,rn `t
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 detennination of compliance with the existing
site plan.
[ ] This site complies with the site plan as of this date.
Notes:
Date L%
Building Official
400
Zoning Official '1{ Date 45 Z, o
Other Official Date
County of Albemarle Department of Community Deveiopmeni
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 / i
Is u i LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y N
Will re 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 ublic water?
If private well, provide Health ent form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that appli
Is parcel on septic o ublic sewer.
Y /
Will e putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y
Wiptierebe 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:
Oe
NNrmitted as: I �! � I lG1 i eve- ("O�i�Si0%� (
Under Section: 2-5- 4. Z• l
Supplementary regulations section:
Parking formula: ( I -ZG O
Required spaces:
Y /
Ite s t be verified in the field:
Wfu
Inspector:
Notes:
Date:
Violations:
Y/N
If so, List:
Proffers:
Y/N
If so, List:
{q f��
i �4�
Variance:
Y/N
If so, List:
� f' O
SP's:
Y/N
If so, List:
Clearances:
' ((Q 36
SDP's
-L , —Z
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 (Hone Occupation, Zoning Clearance, Zoning
Administrator Determinations or Appeals, Sign Perinits, Building Permits) if the application is not the
owner.
I certify that notice of the application,
[County application name and number]
was provided to %�rzt„ �r i, ✓ the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number T &,- Ay': 5-� I",e,;t (9 - sG it 1 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
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 &-j ,ti Jo b
[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_ 2 I I, I 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].
Signature o Applicant
Print Applicant Name
orb I/,9
Date
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Tax Map:
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f See Map Book Introduction for additional details.
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