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Home My WebLink AboutCLE201900095 Application 2019-05-06�'s APPROVED by the Albemarle County Community Development Department Date 5'-A-/'/ '(3 Q -7 N201 1 Gn,yo6l 3asy Application for Zonin Clearan CLE # l ` PLEASE REVIEW ALL 3 SHEETS OFFICE U pNL Check # Date: Receipt # Staff: PARCEL INFORM Tax Map and Parcel: Existing Zoning Parcel Owner: (Z a&Oilf ✓ Lb C 6 ` �/ 0— Zip Parcel Address:UN 0 (Odn l f City l/r � �(, � � State 1� (include suite or oor) 7^ PRIMARY CONTACT ��- �o f Who should wecall/write concerning this project? L1 Address: IJC � jr i a VV44 City r State Zip Office Phone: C Cell # q a q�jax # E-mail aQA 16 APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business Business Name/Type: VIA Previous Business on this site 1� Describe the proposed business including use, number of employees, numb r of shifts, ava lab a ing spac s, number Hof,, vehicles, and any additional information that you can provide: 1 �ti�� +, '1 *This Clearance will only be -valid on the parcel for which itlis approved. If yo change, intensify or move the use to a new location, a new Zoning Clearance will be required. I hereby certify t t I own or have t owner's permission to use the space indicated on this application. I also certify that the information provided is true and ac ur e to the best of y aledge. I have read the conditions of approval, d I understand th and that I will abide by them. C Signature Printed APPROVAL INFORMATION [LIApproved 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 'Y�G%L� Date 5 Ce129 Zoning Official Date Other Official Date County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126 D/ Revised 11 /1/2015 Page 2 of 3 Intake to complete the following: Is / Is u LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y / Will 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 that applies Is parcel on private well or pub ' watery If private well, provide Health ent form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that applies Is parcel on septic or 7fwe> Y/N 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 # Zoning to complete the totlo'vvmg: Viol s: Y /IN If so, Est: Vari If so, P'st.* Clearances: Z ®l — ( 7i 2 O (2 ` 2.3 Reviewer to complete the following: �j Square footage of Use: " oe) /N y� -miffed as: PV ' C elcic Under Section: Z J , 2 Supplementary regulations secti Z-M,4 Zoat - 61-3 for 3 Parking formula: 1 —4a? Ofq Required spaces: Y Items to be verified in the field: Frotters: N If so, List: LMii Z(/O(-03 1-TPA✓bzAl-oy-y SP's: Y /P If so, tst: SDP's Revised 11/1/2015 Page 3 of CERTIFICATION THAT NOTICE OF THE APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER ThN form nura7 accompany zoning applications (Home Occupation, Zoning clearance, Zoning Administrator Determinations or Appeals, Sign Permits, Building Permits) !f the appltcation is not the owner. I certify that notice of the [County a licaon `—name and num erj"% was provided t _ �e o ner of record of Tax Map [name(sj of the record owners o e parcel and Parcel Number by delivering a copy of the application In the manner identified below: Hand delivering a copy of the application to +�j 'Name of the recora 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 _ Dal ® Mailing a copy of the application to [Nance 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] to the following address: Date [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 requiretnentl.