HomeMy WebLinkAboutCLE201900055 Action Letter 2019-04-16APPROVED
by the Albemarle Count
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,M^iq�5'.N Community Development ie a�
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Appficatlon f0'rY�.
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OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS Check # UQ Date: Iq
Receipt # Staff:
PARCEL INFORM T O -
Tax Map and Parcel: Existing Zoning
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Parcel Owner: (Z., ,,/
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Parcel Address. +. city �- : .
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21qot
(include suite or floor) 4 Z6(
PRIMARY CONTACT ^
Who should we call/write concerning this project?
Address : Gt.�.� CityCLj- 101L(Je— V .State Z� 2jzq(--)
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Office Phone: Max �,✓S(: �
4e�li 1114
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: 14e4v 6U�� 6,C
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Previouausiness on this site'
Describe the proposed business including use, number of employees, number of shifts, availab a parking spaces number of
vehicles, and any additional information that ou can provide: C - �y�- t d e UAV- ' M — j �'Q -- 7
5t14_f_._,_Y,4n,, �
*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 t I own or have the f ner's p mission to use the space indicated on this application. I also certify that the information provided
is true and acc ate t the best of m owledg ve read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed c..) �.`�(��✓-,/
APPROVAL INFORMATION
Approved as proposed [ ] Approved with conditions Denied
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[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, 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:
F
Building OfficialACifff Date
Zoning Official D
ate
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
XS
,-A, 6J
Revised 11/1/2015 Page 2 of 3
Inta a to complete the following:
Y/N
Is u e i LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/N
Will e 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 o ublic water?
If private well, provide Health orm.
Zoning review can not begin until we receive approval from Health
Dept, FAX DATE
Circle the one that ari'
o
cow, 7Is parcel on septic c s
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Reviewer to complete the following:
Square footage of Use:
Y /
Pe itted as:
Under Section:A0 Of
Supplementary regulations section:
lei /,I —
Parking formula:
&1` (47 I C`5' fA� P 107tfc--
Required spaces:
Y/N
Ite s to e verified in the field:
5-'kat,n QS ,e a ,;�
Inspector :
Date:
Y / N Notes:
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
viol PNOns: Proff :
Y / N Y /
If S(,�Ist: If s Li t:
iAO
riance: SP's:
Y / N Y /
so, List: If s st:
M 1-
Clearances: SDP's 2.7
2L
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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 (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,
was provided to
[County application name and number]
[name(s) of the record owners of the parcel]
and Parcel Number
manner identified below:
Hand delivering a copy of the application to
the owner of record of Tax Map
by delivering a copy of the application in the
[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].
ure of Applicant
E M 0yV d
Prin pplicant Name
Date