HomeMy WebLinkAboutCLE201900071 Approval - County 2019-05-03APPROVED -1
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Application `fir Zoning; Clearance
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CLE
OFFICE Ur rY } ii
PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Receipt # Staff:
PARCEL INFORMATION
Tax Map and
c : Existing ZoParcelOwner
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ParcelAddress: b if y&LI01 City & State Zip
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project?
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Address : d`//� City State
Zip
Office Phone -La qyL - �6 Bell Q
E-mai
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
+
Business Name/Type:Yal k � 10 k d '
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Previous Business on this site
Describe the proposed business including use, number of employees, umber of shifts, a ailable parking spaces, number of
vehicles, and any additional information that you c 77
r vide:
*This Clearance will only be valid on the parcel for which it is app6ved. If you chahge, intensify or move the use to a new location, a new Zoning
Clearance will be required.
I hereby certif that I own or have the owner's pemtission to use the space indicated on this application. I also certify that the information provided
is true d ac to to a best of my wl dg I ve read the conditions of approval,and them an th I will abide by them.
/understand
Signature Printed fl�U:
AP�P�ttS^AL INFORMATION `
h pproved as proposed [ ] Approved with conditions [ j 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 Ilry Date
1h1laZoning Official 41&bDate J
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 2%-5832 Fax: (434) 972-4126
Revised 11/02/2015 Page 2 of 3
Intake to complete the following:
Y
Is , HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y
Will t ere 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
Is parcel o rivate well 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 on applies
Is parcel o septic r public sewer?
Y / NN
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Inme to complete the tollowma:
Reviewer to complete the following:
Square footage of Use:
i
Penmn
N
itted as:
Under Section:
Supplementary regulations section:
Parking formula: C
Required spaces:
Y/
Items be verified in the field: i
Inspector:
Notes:
Violations: Proffers:
Y/N Y/N
If so, List: / If so, list:
Variance: SP's:
Y/N Y/N
If so, list: If so, List:
Clearances: N .P 'Q/� l Y (I /� ) SDP's
Date:
361� " qO
Revised I I/ 1 /2015 Page 3 of 3
CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
This form mart 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 applicatior�J (/ 1-M dlj�dT— M—V9)
I Efthe
[County application name and number]
was provided tolu t' Ol { i the owner of record of Tau Map
[name(s) of the recordowparcel]
and Parcel Number L
by delivering a copy of the application in the
manner identified below:
Hand delivering a copy of the application to1'(;Z4�
[Name o 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 offs for that entity]
on 74
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
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].
1
WSiature of Applicant
'�pv
Print Applic N e
Date
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4 KESWICK HORSE SHOW GROUNDS
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