HomeMy WebLinkAboutCLE201900014 Application 2019-03-07Application for Zonin Clear
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CLE # -
PLEASE REVIEW ALL 3 SHEETStI:Receipt#
FICE USE ONL
eck # /� Date:
%/ 3 a oZ Staff:
PARCEL INFORMATION
Tax Map and Parcel:
Exist�n`g`Z�ft(C� 0.�
Parcel Owner:_ `5k (p QOIG!►�Q.0 Luc
Parcel Address: rj11Q $Ypd�W(.\y ( City CVk �,�, State VA Zip��(T
(include suite or floor)
PRIMARY CONTACT
Who should werrcall/write concerning this project? Y vu DCN
Address :_-�;1 V sr1ty0VNr4 City CV \ LI,E State VA Zip'L2t}6 )
Office Phone: lN\ I_LZZ Cell # Fax # SC T JlZb E-mail k4i(YL1t *iV10YA-a0f %
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APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use of name _New business
\ _ jChange
Business Name/Type: 10� ma'ykc vc\!q C�\AY fib'} �SV % K I '� % \TA\ M
Previous Business on this site pY)T`Y1V11L
Describe the
proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicles, and an additional information that you can provide:
�
SP a0 r Ac_hk
*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 knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
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Signature • � Printed ��Cf ` �\C T_�) QV \
APPROVAL INFORMATION
Approved as proposed [ ) Approved with conditions [ ] Denied
] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-45 11, xl 17.
[ ) 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 Officials Date
Zoning Official Date
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
M
Revised 1 ] /1/2015 Page 2 of 3
Intake to complete the following:
Y N_.
Is u m LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y
A t 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 blic wat
If private well, provide Health artment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that ap Ces)Is parcel on septic or
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 complete the following:
Reviewer to complete the following:
Square footage of Use:7(Q
Y/N
Permitted as:
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces:
Y/
Item be verified in the field:
Inspector : Date:
Notes:
Viol ion :
Y/N
If so, List:
Prof rs:
Y/
If so, ist:
V a ri
Y
If so,�N,.,'
st:
SP's
Ifs S.
Yam'
Clearances:
6
SDP's
A� -S-7
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60 - 7v
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Revised 11/1/2015 Page 3 of
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, Z06 V\o!N CDI L-AJaYN-LX
[County kplicZion name and number]
was provided to 6\ U `,-,x-b O`Gy-,! -� Lt— (— the owner of record of Tax Map
[name(s) of the record owners of tht parcel]
and Parcel Number
manner identified below:
by delivering a copy of the application in the
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 12�
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
Print Applicant Name
kIUS11-01
Date
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