HomeMy WebLinkAboutCLE201900067 Application 2019-05-06APPROVE1.
by the Albemarle County
Community Develo_ •tint Department
r)nta -5-- 4 --tri
0.3-7,51 55 k•G3y2NY
Application`f�o-r Zoning Clearances
CLE # �Q �j�
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OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS
Check # '/Y Date:
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: LA i�i) , or) 0 17 DO Existing Zoning FDS
Parcel Owner: Pan��%' S svIW,p, y)o
Parcel Address:Gb Li Pa-f-oIOS Ct�,,i Cr ity � ' ✓ t � Statey6( 2,22`31
Zip
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? A ; c liae(
Address: Pin•,Ps City�h State %,14 Zip q l/
Office Phone: y.3c o�93 aIW,2l_1 Cell # '/31/-S3i-max # E-mail s `(,l
APPLICANT INFORMATION
Check any that apply: _V Change of ownership Change of use Change of name New business
Business Name/Type:
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 additional information that you can provide: Ll " ro.e/w,Pe,� / Sh. f
B — 5— t �a �4 51e:w cQ �
*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.
1 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 accurate to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature ,✓11jJ VX_ Printed Ar` � a %
l�f4 Ili n
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
Building Official Date
Zoning Official Date 5._ t(
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
7441
Revised 1 I/1/2015 Page 2 of 3
Intake to complete the following:
Y /�'e'f Is u n LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
Wil re 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 blic w
If private well, provide Healt Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applie — —" —,
Is parcel on septic o ublic sewer9
Y
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit. f
Permit # R `V�T QtC`c5�i11j
Y Wi elTih re 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: f* 2 D 0 4
YY N
Permitted as: Apl'keAiG
t.1a re 2 2, 2, 1 �h) Cz)
i
Under Section: lauv r 13eqlt�z
Supplementary regulations section:
2olq-13
Parking formula:
zcc�
Y�V YS. C,
5t 0(--tt,1
Required spaces:
5 Dial R Yg -11 g
Y/N
Items to be verified in the field:
A) o 6x ek-o (,
L-19
Inspector :
Notes:
Date:
Violations:
/N
If so, List:
n
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Proffers:
Y`YN
If so, List:
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ZDo$- 73
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Variance:
LY)/N
If so, List:
VA 1q,S5-5'
SP's:
Y/N
, If soList:
SPIN-OT,
625-07
VA 1911-
Clearances:
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SDP's
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' S�J1957-136,
1993-26
Revised 11/1/2015 Page 3 of 3
CERTIFICATION THAT NOTICE OF THE ,
APPLICATION HAS BEEN PROVIDED TO THE LANI)OWNER
This form must "compatky zoning applications (Home Occupativn, Zoning Cktuwtce, Zoning
AdmiuLT.tratorDelermirrations- arAppeals, Sign Pemdtv, fitrikUng Permits) if the appUcarion is not Ow
owner.
I certify that notice of the application,�7
[County application name and number]
was provided to _C h 5 et e ri, the owner of recc rd of Tax Map
[natuo(s) of the record owners of the parcel]
and Parcel Number______ __ _____by delivering a copy of the ;ippliemon in the
manner identified below-
Itand delivering a copy of the application to
[Name of the record owner if the rou)rd owner is a
person; if the cmmcrofrecord is an enlit.y, identify the mcipient of the record and the recipient's
title or office for that entity]
On
Date
LIES Mailing a copy orthe application to �, A
—And,, 4 r 4-
tNrunc, ofthL reicoird owner ifthe record owner is a person,
if the owner of record is an entity, i4critify, the recipient of the record and the recipient's title or
ofloce for that entity]
On -�4 - I - I ! -.-- to the following address:
- bate
[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 cttac tax w—messinent ree�ords satisfies
this requircinenti-
Signature. or Applicant
Print Applicant Name
Date
I