HomeMy WebLinkAboutCLE201900102 Action Letter 2019-05-14APPROVED
by the Albemarle County
Community Development Department Date q Kp HgCj- 0 3 9a-1-39qU L
Application for Zoning Clearance
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OFFICE USLONLY 0
PLEASE REVIEW ALL 3 SHEETS
Check # (,'C Date:-1-13
Receipt # Staff:
PARCEL INFORMATIO` rydd�� �
Tax Map OA /Vf ()()GOD CA
and Parcel: WV Existing Zoning
Parcel Owner: 1�W pa� S {/``
Parcel Address: J ✓ lL J ti12—lity (,h v I I U— State V Zip tj t
(include suite or floor) Su I. �C)
PRIMARY CONTACT
Who should we call/write concerning this project?
Address :� �' `r �C O ��t City 1�� State �/ !/c Zip
Office Phone: — SQ��1
# Fax # E-mail IIV x
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APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
WUAMMIA,
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Business Name/Type:
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Previous Business this &I MI E
on site
Describe the proposed business including use, number of employees, number of shifts, available parkin spac ,, number of
vehicles, and any additional info r ation that you can provide: ( G
19- s acmes 2 1pe—es - -
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*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 oning
Clearance will be required.
I hereby certify that I own or have the owner's permission to use the space indicated on this application. 1 also certify that the information provided
is true and ace ate to the best of my knowledge. I have read the conditions of approval, and 1 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, 977-4511, 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 �
Zoning Official Date 13 ZO/ I
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
164.
cC*11
Revised 11/1/2015 Page 2 of 3
Intake to complete the following:
Y /l.:l
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y
W I 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 p lie wa
If private well, provide Health epartment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that appli
Is parcel on septic or t�-h w -
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 comnlete the following. -
Reviewer to complete the following:
Square footage of Use: 1 j4 % F
� rmittedas: ��i/1, ��D'JS►U��� Oir��r<<S
Under Section:
Supplementary regulations section: /kj /tq
Parking formula: 1 / Zoo /I / S F
Required spaces:
Y /
Item o be verified in the field:
Inspector:
Notes:
Date:
Viol +ions:
Y /(NJ
If so, ist: v,�e
�
Proff s:
Y /1
If so, Est:
Var' ce:
Y /N
If so, Est:
SP's:
Y
Ifs Est:
Clearances�E -GOI -ZS�
SDP's
5 0 P_ 1 9 G 0— 3 1
CL£ 70,5 -Z30
5AP- 1169- �g
Revised 11/1/2015 Page 3 of 3
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