HomeMy WebLinkAboutCLE201900081 Action Letter 2019-04-25RPROVED
Ly ine Albemarle County
Community Development Depar men!
Daie
Application for Zoning Clearance
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY y/ol
C�k # Date: `7
I%ceipStaff:
PARCEL INFORM TION
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Tax Map and Parcel: �Q(� -�d `OU '" d T �/� y Existing Zoning
Parcel Owner: �liC) - /e-
Parcel Address: S,, , 44- City 4n/43 fvj/,2State Zip
(include suite or floor)
PRIMARY CONTACT
Who should we call/write cone ing this project?/�
Address : /��J /� (/� City (���lo%/4State zip
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Office Phone: ( Cell # LX—fax # E-mail n ���"Q0
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APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
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Business Name/Type: C(/I s 6 f��
/ �Q
Previous Business on this site
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicles, and any information that you can provide:A
3 o.� /�/, .� c
,additional
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*This Clearance will only be valid on 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 1 own or have e owner's permission to use the space indicated on this application. I also certify that the information provided
is true and ac a to the best of y knowle . have read the conditi s of approval, and I understand them nd that I will abide by them.
Signature Printed
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, 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 Official Date
Zoning Official Date ¢ �o`
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
4° —
Revised 1 1 /1 /2015 Page 2 of 3
Intake to complete the following:
Y/N
Is us in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /N
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 well or lic 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 ap li
Is parcel on septic o public sewer
Y /6)
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
ZoninE to comDlete the following:
Reviewer to complete the following:
Square footage of Use: �J
Perm tted as:
Under Section:
Supplementary regulations section:
Parking formula: ! / Zoo
Required spaces: 2
Y /
Item o be verified in the field:
Inspector:
Notes:
Date:
Viola 'ons:
Y rN
Ifs t:
None
Proffers:
Y/
Ifs st: n ON—
Vari ce:
Y/
If so, st:
JV Oet
SP's:
Y/�
If so, ist: Nope
Clearances:
SDP's
sop
Revised I I/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,
[County application name and number]
was provided to the owner of record of Tax Map
[name(s) of the reco d owners of the parc 1]
and Parcel Number
manner identified below:
by delivering a copy of the application in the
Hand delivering a copy of the application to %M r►.� _
[Name of the recor owner if the record ow
ne 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 3 17-/
Da e
Mailing a copy of the application to rh ( v^
[Name of the record o ner if the record owner is a e son;
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
3bz- Jk 107
[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].
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Signature of Applicant
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Print App ican ame
Date
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