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HomeMy WebLinkAboutCLE201900049 Application 2019-03-15i i 3-P-0c7 i C LE 20(c7-Ctiq Application foi � ' ning Clearance 3 �_l3 OhhIC1: 11NF, O I,Y IPI. EA S F REX? IEAV A1,1, 3 SIIl ETS Check # Date: Receipt # Staff: PARCEL IN>:OR11 VVION ( Tax flap and Parcel: _�i Q f1 a 0 — V �°�1 .- 00 ``— 0 ( 9510 Existing %nning Parcel Owrner: IF SY) cySs I.LC, Parcel Address: I�1�Q &7y �kn&kz T( I' City Cm ll��\�yt M.te VR Zip (include suite or floor) PRIMARY CONTACT �t 11^^ Who should we caal\Uwrite concerning this plr�oject9 k rJi � �� r In-TA Address:- J� With r i S-- City � State N� Zip3iuc Office Phone: Cell #o7r- ` j 1� fax # E-mail 4 1p. t11aitt' (1-i"il� �G 1� 1�ori)' ► APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business Business Name/Type: Previous Business on this site W 10 S-Mack, 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: C C, i 1 (LlK S`F *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. 1 also certify that the information provided is true and accurate to the st of my know l have read the conditions of approval, and I understand them, and that ) will abide by them. Signature Printed_ __J�A9 W dtL200016 Uf L APYROVAL INFORMATION [0 Approved as proposed [ ] Approved with conditions [ ] Denied [ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, xI 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 Official �' Date �j Zoning Official Date Other Official Date x,ounry or Atoemarie Department of community Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 9724126 Revised 11/02/2015 Page 2 of Ir,w_i . c;`y-n 6aaa- 583a201_/-��,5-5 Scanned by CamScanner Intake to complete the following: Y / Is u nI, HI or PDIP zoning? Engineer's Report (CER) packet. If so, give applicant a Certified Y Wi 1 �thebe 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 wyat� If private well, provide Heal apartment form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that applies Is parcel on septic or blic sewer. Y 1/ N ,Vi11 you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # VN there be any new construction or renovations? If so, obtain the proper Permit. Permit# 6ZG(1?-,7$.3 Zoning to complete the following: Reviewer to complete the following: Square footage of Use: Z�60 0 l ce N dtted as: lz r,�Cj (( $ y(C S Under Section: Z.5, Z r ( —> 2217, I Supplementary regulations section: Parking formula: 1 Required spaces: ILI Y/N Items to be verified in the field: Inspector: Notes: Date: Viol s: Y/ If st: Proffers: Y/N If so, List: L MA Z ©1J Vari Y Ifs st: i Ao�_Zof ��(�� V ✓ //s:��' I Y b--I' fts , ist: 5 h 1�73 C i�;1�k�% � wo � Clearances: Z©[7-76,2o16-IZS W/6_ Z� 0 SDP's 2ooi -�u l��S�58 1�85'ZS I�$y-y 2of3-l'b� Z©12 -2y�. 20(D—Zt9 V rs Iq Z-fb [qg0-� MI r ` K KrwK S 4 ks C,V Revised 11/1/2015 Page 3 of 3 CERTIFICATION THAT NOTICE OF THE APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER This farm must accompany zoning applications (Ilome Occupation, Zoning Clearance, Zoning Administrator Determinations or Appeals, Sign Permits, Building Pcrmits) if the application is not the owner. I certify that notice of the application, [County application name and number] was provided to the owner of record of Tax Map [name(s) of the reeora owners of the parcel] � and Parcel Number u- 0 ` 00-70I -l]y delivering a copy of the application in the manner identified below: NI Hand delivering a copy of the application to N1a+� Vj,Iecl SUe Prw er-� [Name of the record owner if the record owner is at�a��l/ 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 S� 1-3I (� Date Q 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]. Sign e of Applicant �A9zo �on�lz6�t�- Print Applicant Name 03J11114 Date Scanned by CamScanner a 0 Fr a � � O �a � w t- z d z w z w U Q a