HomeMy WebLinkAboutCLE201900073 Application 2019-04-16APPROVEi)
by the Albemarle County
Commun' Department
1-l- C - C
Application for Zoning Clearance
CLE # o2O6 - Q-
OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS Check # Date:
Receipt # (�j3s Staff:
PARCEL INFORMATION
Tax Map and Parcel: �' 7 300 - 211 CO Existing Zoning r jqy m
Parcel Owner: Lo xe
Parcel Address: 2_1 o 6pu1r f t-24 I City State L/
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project9 kt(&U,,� c -Da V-,-0 l�
Address: City L/Lr, dte U+ Zip
Office Phone: (_) Cell # %D-0Xq Fax #
APPLICANT INFORMATION
Check any that apply: Change of ownership Changeofuse Change of name New business
Business Name/Type: LLy4 C =I& — yL&P d.I`[1�
Previous Business on this sit �e P
Describe the proposed business including use, number of employees, number, of shifts available arking spaces, number of
vehicles, and any additional information that ou can pro ide: �n.c t% c 0o4 —S k r-,
'
*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 accu e to the best m kn le . I have read the conditions of approval, and them, and that I will abide by them.
XAof ,Iunderstand
Signature Printed �aU ",-C_ rk JB Lr O .
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APPROVAL INFORMATION
[ ] Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-451 1, x117.
[ ] 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:
01
Building Official Date
Zoning Official Date ( W, l
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
Revised I I/1/2015 Page 2 of 3
Intake to complete the following:
Y /
Is us LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y l(P
Will there 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 we �r public water
If private well, provide 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 septic 2rjrublic sewer?,)
YIN
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
YIN
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:
—r
I
Permitted as: AV(
Under Section: 13, Z
Supplementary regulations section:
Parking formula:
Required spaces: 7
YIN
Items to be verified in the field:
Inspector : Date:
Notes: / "
Violat. ns:
Ifsg, ist:
��
Proffers:
If so, ist:
Vari e:
Y/�
If so, ist:
� /
SP's:
Y/6
If so, List: � /y
Clearances:
7_074 5 , 36I -O F2
SDP's
Revised l l/l/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,
[County application name and number]
was provided to ` ` the owner of record of Tax Map
name(d) of the record owners of theParcel]
and Parcel Number
manner
identified below:
delivering a copy of the application to
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].
Print Ap1/0
icant ame
Date
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