HomeMy WebLinkAboutCLE201900094 Action Letter 2019-05-15APPROVED
by the Albemarle County
• Community Development Department
Dade
Application for nn' ClearancecitT
;��► � l
CLI<
_ C
OFFf(k 1 -
PLEASE REVIEW 1LI.3 SHEETS � Check
Receipt # Staff:
j PARCEL INFO.RM1_A_TtONTax flap and Parcet: �Existing Zoning � � PX1 Cc✓t
Parcel Oviner:_Ph.,Ul",`� —
Parcel Address; �Q �,(�h_ ! _U___ .!__4 11a7r7_�. C:it�' r1Q � eso lkState .... Zip ���/mil
(include suite or floor) [
PRIMARY CONTACT
1L'ho shouldwe callhvrite concerning this pro,ject`.'fil
' :Address 9� � I'�ec.Jt70d� �Vil"I
-- City, ��G_9�r_�PSvI 1(� -tate
{ Office Phone:
APPLICANT INFORMATION
Check any that apply}__�_,_._..____ Change of oivnership Change of use — Change of name _New business
i Business Nanae/7•ype:�StCi10_.—�%aJ�s�'
Previous Business oil this siteotJl �Gt i „_�CQ
Describe the proposed business including use, number of employees, number of sh'fts, a a*I ble Marking spac - t� el
f
vehicles, and any : dditionat information that you can provide: e elf I �_�
�._._on__.re; S
This Clearance will only be valid on tl)e parcel for which it is a - - -__—
}proved. If you change. Intensify or :rove the use to a neva location, a new' Zoning
will he required.
I herehv certify that I own or hove he ovv-n s petsnttsiorr to use the space indicated on this application, I also ce ,iti that the inii)rins itio❑ provided 1
{; is true and accurate to tile: best of my knonA i edge. I have read the conditions of approval, and I understand thens. ally. that I will :rbidc by ihern.
! Signature -
�2c-- Printed
I AI'PI2OVA.Ls INFOit �I��, PION
Approved as proposed I j Approved with conditions [ j Denied
[ 1 f3ackilow prevention device and current test data needed for this site. Contact AC SA, 977-451 1, x 117.
[. ] No physical site inspection has been done f ,this clearance. "iherehsre, it is not a determination crl'eonnpliance with file existing =
site plan.
j I This site complies with the site plan as of this date.
Notes: -- ---- -- -- —
Building Official Date
Zoning Official Date
j Other Official —_� _ Date _—
I-............
County of Albernarle Department of Community Development-
401 :)rlclnttre Wait C"'harlottesvalle, VA 22902 !'vice: (434) 2965832 flax: (434)972-4126
Devised 111:201 j Page 2 of 3
Intake to complete the following:
1' Q
Is use in L.I, III or PDIP zoning:'
E�.it_incer's Report (CFR) packet.
If so, give applicant a t:'ertified
}; ,
Will t ere be food preparation?
lfso. give applicant a Health Department fwrm.
Zoning review can not begin until we receive approval from I-leaith
Dept. FAX DATE
Circle the one that applies
is parcel on pr iv ttc"all of ablic rvat �Ur t li��`
If'private %veil piovide Health _ epariment ti�rrn.
Zoning revicwv can not begin until wve rec-give approval from Health
Dept, FAX DA`IT
Circle the one that applies
Is parcel on septic or i-CS ewcx:
y N
Will you be putting; tip a new sign of an} kind'
Sign peirmt.
Permit It
Ifso. obtain proper
1'
Will ere be any new construction or renovations?
If so, obtain the proper- Pennit.
I'errnit it
ltevie, er to complete the following:
Square lootage of Use: — _S_J_._.___1
N Qom( L
itted as: 1 luMrj j�i m }1t'_
Under Section:
Supl�Iententary reggulations section:
Parking forrnula:
4
Required spares: 3
V N
Items be verified in the field:
Inspector.:
Notes:
Date:
1
3
Zoning to Comolete the follots'in
Viol ns:
J Y jKA
'
j If so, _tst: If sot:
i No/it,
._._ _-- _
FY 1" ' '
If so, t. If sc, t:
3
Revised 1 1 1 20 15 Page 3 o f 3
00
-P
N
�
N_
O
n�
0
N
00
O
rD
v
Ln
0
-
0
3
Ln Fn
00
CERTIFICATION TI-IAT NOTICE OF TI-IE
APPLICATION f1AS BEEN PROVIDED TO THE LANDOWNER
This form must accompany zoning applications (Home Occupation, Zoning Clearance, Zoning
Administrator Determinatio s or rAeals, S1 n Permits, jj�M if the application is not Me
owner. o W W (S t C /q 0 —r—
I certify that notice of the application,
was provided to
[County application name and number]
[name(s) oNhe record owners of the parcel]
the owner of record of Tax Map
and Parcel Number --- \ ______by delivering a copy of the application in the
manner identified below:
Hand delivering a copy of the ap lication to
c ap lic [Name of the record owner if tile r er i
\-atli apiers r1sa
person; if the owner of record is an , tity, identify - Allreo
y the recipient of the record
title or office for that entity]
ME
Date
Mailing a copy of the application to
[Name of the rec\d owner if the record owner is a person;
if the owner of record is an entity, identify the recipient o 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].
Signature of Applicant
Print Applicant Name
Dale