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HomeMy WebLinkAboutCLE201900051 Action Letter 2019-04-05; lr� Alnernarie County Department Application fir ® inaCle arance 6H, 1 JCL L.S )N[. Y PLEASE REVIEW AI.,L 3 SHEETS Check 4 �_���� Date: � �• _ eceipt :t , � (0 Staff: ,T1//J A A PARWEL INFORMATION Tax tfapandParcel:.C�_(o000•oQ._..QO� Oa, -PO115�St_ o/ ._ .0 l�u c t+;xist]nn Zoning Parcel (hvncr: R-P Parcel :address: a_`i.al?'.�em..�__. C'ity��.p��V.t.��.�. 5t.ateI� .........__ Zi>22 (inclu e suite or floor) 12 .. .................. _...__ PRIMARY CONTACT_ Who should we call/write concerning this project? >� Add ress : a City State Zip 221J pZ Office Phone: Celli3�ti�L_�..g.iz.� Fax #'y3� APPLICANT I;S'I�ORti7ATION �- - _.. - heck any that -ppChanl;c of ownership Change of use Change of name ✓ riew business i Business Nan e/Typc: _V�10-+,C Previous Business on this site__ —�" S etaC�..�► Describe the proposed business including use, dumber of employees, number of shifts, available parking spaces, number of vehicles. and any additional information that you can proyidec sa b�S.s-„ssi1, *"1 his Clearance "ill only be valid on the .arcel for which it is approvcd. 1 you ch.inP.e; or move .he awe to a new location, a new Zoning Cleatanec will he required. I hereby ceruiy that I own or h rce Uric o� ne r s per -mission to use the ;1 ace indicated or: this application. I also certify t]'rrrt the initntttation provided is tru; and LiCCLNOte to the hest of my krowled ge. I have: read the condinons cl approval. and 1 understand them, and that I �%ill abide by thn- Signature A ............. [ pproved as proposed [ I Approved with conditions [ J Denied 1 I3ackflow prevention device and,'or current test data needed for this site. C'orriact AC'SA. 977-451 1 • x] 17. ( .J No physical site inspection has been done fc>r this clearance. Theretore, it is not a determination of compliance with the existing site plan. [ ) This site complies with the site plan as of this date. Notes: i Building Official _._. __._. Date __...._ _........___ Zoning Official _^._._.....____ Date_�.__�._ Other Official Da I ..__.... __ ............ _:._ _.......... county of ,Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 >832 Fax: (434) 972-4126 Revised I i1,1;20] 5 i) gc = of Intake fit complete the following: Is ttCci—I�Ll. Hl or PDiP zoning? It'so, give applicant a C'ert Teti 1?ng,ineer's Report (CHR ) packet. Y Wil rere be t-ood preparation? 1f'so, give applicant a health Department form. Zoning review can not begin until we receive approval from health Dept. FAN DATE Circle the one that applies .,-� Is parcel tan private well or b Nvat.er? If'pris-ate N ell, provide Ilea nt form. Zoning review can not begin until Nve receive approval from } feakh Dept. FAX DATE Circle the one that applies pu c sewer? Is parcel on septic or Y , N Will you be putting up a ne�v sien of any kind? lfso; obtain proper Sign permit. Permit # Y ; \' Will there be any nevv construction of renovations? 11 so, obtain the proper Pennit. Permit # ZonintZ to complete fate fall t labors: N so, List: Z i `10 2 ©D 7— ('learances: Zoe 8 "6o 2D( -d ._ .._._._...............__.... s-y� ._......... Pt.3...`_y.. 2vtL_.� Re -viewer to complete the (following: Square ti>otaze o{ t se: ` Q 'i C75Z tj,( t N l itted as: P�r�1f_f.'_�_ 1 ��'S Under Section: Supplementary regulations section: I — Parking forntu(a: /20% )* Required spaces: Y 1 It".r be verified in the field: Revised 1 1'1/2015 Page 3 of CERTIFICATION THATNt)TICI OF'TI�F APPLICATION N 14AS BEEN PROVIDED TO HE LANDOWNER Thisforin inust acc•ornpru{v roni►ig vivivations (llume Occupation, Zoning C'hurance. Zoning Admini,rtrutor Determinaiious ur,1 ppeuls, ,Sign Peamdts, Buildhig Permits) {'f the application is nut the e wm r. I certify that notice of the tapplicaiion, l` (('r?unty al,'piicnlirnt name arid numtacr] was Provided to ` sue,- ' , _ _ _.. the ocvticr of recorel Of' Tax Map (name(s) of the record owners of the parcel] and Parcel Number C>(QcZj :©C�Ci�.�..i5i5�10 by delivering a copy of the application in the manner identified below: Hand delivering a copy of the application to -- (Name of the record saner 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 fur that entity] _ Mailing a copy of the rapplicatiort to (Name of the record oauer il'dle: record owllu is a person; if the owner of record is au entity, identify the recipient of the record acid the recipient's title or office for that entity) r,n --- _._T- ____.,___.._-- to the following address: Date (address; written not nr+iletl to tire c,evrtcra; thee last ki,t,wn address of the owner as .shown on the current real estate tax a"Cssrne:nt hool c or ourrent real estate eax <assessmew records satisfies this requirement] �rgi'itteuc ofr"Aplzlicn __ Print Applicant Name r%,tr: Exhibit A Striped Area Is Suite lr- 1�-(C) EUFC PANLI MECH P!, 1`117CHANW.Al RM FIRST LEVEL 21,21 IVY ROAD I ? 3 Aie") u10;1 NMI 77 Sl 15, t, I — . 713 Sr 233,1;F :It OADIN6 AREA