HomeMy WebLinkAboutCLE201900093 Action Letter 2019-05-10APPROVED
by the Albemarle County
G^mt unl v nevolonmo.nt r�P.f`"�riTE l
Application for Zoning Clearance
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CLE # a�1� - 'j3
� 4-_�-_ ;.
OFFICE USE ON Y r
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PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Receipt # Staff:
.24
PARCEL INFORMATION
1�
Tax Map and Parcel:.. 06apo.-� a)-O(j^�QC j Existing Zoning-Cfiq kI/�.i�y
Parcel Owner:
Parcel Address: 2-2_( A City CA/ ( I le- State V A Zip7a0103
(include suite of floor)
PRIMARY CONTACT
Who should we call/write concerning this project? y ,
Address: �' j T -eCli- 1 L4" -C City State Zip a- k 6
Office -Phone: 1 `i .S - ell # _ _ 6-7;` _ Fax # E-mail Sen pt c z jC1.
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: P-l o Toy c I'Pcj )1-Pi-_
Previous Business on this site PTO "11 C J
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: v- 1571:30 �4 a
*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 accur he best of my kDowledpae. I have read the conditions of approval, and I understand them, and 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, 977-45 11, x 117.
[ ] 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 5-/o
Zoning Official i� 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
9ti'4
Revised 11/1/2015 Page 2 of 3
Intake to complete the following:
Y /a
Is uLl, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
WY il e/I Tf 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 o ublie wateutform.
If private well, provide Health epa
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applie
Is parcel on septic or ublic sewer?
Y / N
Will you be putting up a new sign of any kind?
Sign permit.
Permit #
Reviewer to complete the following:
Square footage of Use: 15$0
�24 �(�2• Z�� 10rmttedas: 2
Under Section: L-aVn d ree S, J try (, l euyt e-f S
Supplementary regulations section: ` 4- (�
Parking formula:
1001,6F f,(- 5-WO
1 (Z00 NrF t 3700O
Required spaces:
�-� 13
Y/N
Items o be verified in the field
IS-1 Gt✓cr�lu�/e s" Puce" �yw� o�
If so, obtain proper
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Inspector : Date:
Notes:
Viol ons:
Y /
If sou"',
o, ist:
�S ,�
Prof
Ifs/t:
)\j o a e-
ariance:
Y/N
so, List:
5ijO; 5 cfbu L VSs . Aid %vil d,?jam � fs
"s:
(�Y�/N
so, List:
2 - 3 N / �l
Clearances:
C L�-zol��zz3
SDP's
so?- i Qgq—f3
20,b-1q7
TAP )R9-7- 37
2015 - -Lu
ZAr cO - ZW
Revised 1 l/ 1 /2015 Page 3 of 3
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,
was provided to
[County application name and number]
[name(s) of the record owners of the parcel]
and Parcel Number
m:n/nerentified below:
Hand delivering a copy of the application to
the owner of record of Tax Map
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].
Applicant
Print
Applicant Name
Date
2� o T y Ceea., e.T