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HomeMy WebLinkAboutCLE201900101 Action Letter 2019-05-10'\-PPRO E by the Albemarle County Application for Zoning Clearancear CLE # 2019 " 'QQ 101 It PLEASE REVIEW ALL 3 SHEETS OFFICE USE ONLY Check # q;L'o Date: "✓ l Receipt # Ji7 l 4 !J Staff:-JFA�- 2t-A-r PARCEL INFORMATION __ o 6-1 Tax Map ©q'500 " - 00- F and Parcel: 00 104 C� PG /UA Existing Zoning - Parcel Parcel Owner: i`� 0\tU­14i tj , Parcel Address: 2-� City l�1-t0�,{1Q 116tate VTf Zip 2,2,qO (include suite or floor) PRIMARY CONTACT Who should wecall/write concerning this project? Address : )`� �% &- O(tlL S4 City k nr I CO State VA Zip232g y Office Phone: ( 4P ` Cell #(?)0 Z Fax i A0 %JI 2l, ' E-mail Llw ka tn(w— N-e y } 3k4S --r— J2'1 S 13-( Z i v t4 3 c APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business Business Name/Type: Pu-� 4" t `JrC _k �t �6-&L(�l, Previous Business on this site �2T� 4' L-Ck bno J p 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: 2 uiv: i LiO+ t 1`rc i Am CA, I Lr 1 %-� - + j&S zr-cr- -Carr. *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. I 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 Printed Lu' n,, fyui T O D 4c' /Y) ' APPROVAL INFORMATION jTfApproved as proposed J Approved with conditions Denied [ J Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-451 1, xl 17. I I No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing site plan. [ I This site complies with the site plan as of this date. Notes: Building OfficialYAW Date Zoning Official Z Date �' / Z Q I T Other Official Date k-ounty or Amemarte liepartment of Uommuntty Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126 qoarzl C6ka),ca,,ak,w,, Uokky)l lor Bow-ac�4 ecA 0 ,td �„,at rtx (B)i4) M C43a,,d- + t �1r �� L91 %(A- p � Revise 11 /02/2015 Page 2 of 3 Intake to complete the following: Y / Is use in LI, HI or PDIP zoning? If so, give applicant a Certified el Engineer's Report (CER) packet. Y /Ifi Will t e'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 pu lic wate 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 applies Is parcel on septic or li se Q11 N you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # P Z 019 - 7 3)_ 5 Y / N Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # Zoning to complete the following: Reviewer to complete the following: 6j gd `jo Square footage of Use: 5-7 Zb ���✓� KL4, Perm tted as: ` I'ybt t p lk Under Section: 2 , 2. ' ( b��O Supplementary regulations section: % Parking formula: l et Required spaces: 2-3 Y/N Items to be verified in the field: Inspector z Date: Notes: vei 00 Pal,C,,y �(c((fI Peg — Viola ' ns: Y /� If so, ist: Proff s: Y /� If so, List: Variance: Y / If s tist: � l L)O( 's: Y N so, List: f� _ � l✓ � � 3 L 6tf✓�ryS �QI�I�% Ct►Aer T4 ;4 Clearances: 2�1H- 17 t, Z© 10 zc� SDP's s` fl 11111 -12 Revised 11 / 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, C L L Z0 ` 10 1 [County application name and number] was provided to �(OQ 4�- N-J. i T1 Q, � I LL(, the owner of record of Tax Map [name(s) of the record owne s of the parcel] and Parcel Number (,)Lj5-00—O0-00 --jQj e r QCtjcd by delivering a copy of the application in the manner identified below: Hand delivering 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 Mailing a copy of the application to N o V t Eq j(+ e-S , U (A - [Name of the recor o� wner if th 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 L�I �,(p (l� to the following address: Date 1nAu ,nu 4 o rA A-s)& ,w ,U- (K) lbxl � ,-( ? 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