HomeMy WebLinkAboutCLE201900105 Application 2019-05-20APPROVED
b y the Albemarle County C � I I? - 0
Date -.�-A _Z _-,_p�li�c__. a__.fi__ amf6 0 o- nIipn Clearance
File CLE#.OFFICE
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PLEASE REVIEW ALL 3 SHEETS Check # `7 Date:
Receipt # I 114 A a0i Staff 7 A, fj n
PARCEL INFORMATION
Tax Map and Parcel:
al (r _ 1� (� ((X7)() Z_L� Existing Zoning Q T16) S
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Parcel Owner: ") � to S
P -r�E I �®
Parcel Address: 3S5 ffi CbftJU`LW t�.Dl'�D7�City 0knrb' U41U- Statey4 Zips 3
(include suite or floor)(
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PRIMARY CONTACT V�d
Who should we call/w,ri`te�concerning this project? Qr L
Address : Fj2_%llUU. 1 g4ee Apkil City 1� J State
Office Phone: Qq) 1 -IS Cell # 0y -11 1.2531 Fax # E-mail
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APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: \y ,,•,,C�
Previous Business on this site Iypt'v--P,
Describe the proposed business including use, number of employeeg, of shifts, available parking spaces, number of
�n.unmber
vehicles, and any additional information that you can provide: i-lA SWO a 4i ...- &X§0> 1 r-10
L` Ux S c—k VIYYC' , 17 s dvc S CY V1 c.¢_-) 1 c
ek
*This Clearance will only beWalid 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 TOM ).,yiYl-4 koGkcf(
AP OVAL IkFOIRMATIONU
[ Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, 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 Date 5�7`/i9
Zoning Official Date S-�
Other Official �— Date
Uounty of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
Revised I Ull/2015 Page 2 of 3
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Intake to complete the following:
Y / N
Is LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
Wi] 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 u wat
If private well, provide Healt epartmeni form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies--- ��
Is parcel on septic o lic sewer?
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 pro er Permit.
Permit # (32v( —00)Z
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: Z 770
�O *j9'
-''
Y/Np
f7ermitted as:
Under Section: Z 2, Z, 1 r
Supplementary regulations section: ---
'502017-C 2-
Parking formula:
f Mevt -f7-
Required spaces: Cideyuy4,e y)u✓k�1�cl
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
violations:
1 tfso, ist:
Zc(7- 256
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:
st:
TY
20oG-v .6 -o�.
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Vari�yce:
Y //
If so, List:
VA Cl6 -�� C 'tf��'v�,
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SP's:
Y / N
If so, List:
2015-z Zv-0� 2,1&7 -�
L31T
76 RI - LA
Clearances:
2c�(9-7? 2c�c5-l$,Z�rS-CS,
SDP's
2�rS'-1�, lot _25, 2c)(7_eZ
20(%-
2�Z6 '2e)tS 6,
201A-rti�_
4
C P 76 141 -2
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Revised 1 l/l/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, l- L e2-D I q DU Q
[County application name and number]
was provided to�'�• �-� rn tJ ��. the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number M(g M 1 - U) - Otj - Ud200 by delivering a copy of the application in the
manner identified below:
0 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
[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 "2-0 1 to the following address:
Date
16ra 6t • ry 362—]
[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].
Signa o plican
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Print Appicant Name
VA �01
Date