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HomeMy WebLinkAboutCLE201900112 Application 2019-05-23APPROVED L' the Albemarle County onunur,lt .lent Uepartment (DLif NM 3R(A Application for 4oning Clearance CLE # O k PLEASE REVIEW ALL 3 SHEETS OFFICE U NLY Check # � Dater - Receipt # Staff: PARCEL INFORMATION Tax Map and Parcel: 0 — 0 1 - 06 ~- 00(p � Existing Zoning bUS(Y)eSS 6 c- Parcel Owner. �(�. d/v, Rk'� Lq-un cloy- vHwte►-c, k( Parcel Address: c�3b5' i,r'\vrcn 102�Eh , city ChaA641e, 'fie State ��— Zip�gv L (include suite or floor) S`� PRIMARY CONTACT CG Who should we call/write concerning this project? Sri a n ryk ►rd Address: V37 PjYL1 a r\� City eS 60fib State _ V q Zipo� .!} Office Phone: r ' ' (� Cell # y Fax # E-mail �j!_ �` ctht'tCL.h`letYie_Cord 1L_ ,gin 01 i Ctq-y-�, APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name _ ^New business Business Name/Type: -FIL,+j —r and Wn,31 LIL Previous Business on this site 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: IUSh e1c�2 �1`yn5.i- �.i4ncj j �e Cyl 1 C,u S $-�►�r.Q-� � �i fi mom, *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 r�ayd^H conditions of approval, and I understand them, and that I will abide by them. Signature, /1 c� Printed APPROVAL INFORMATION [Vj(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: t Building Official � Date Zoning Official Date Other Official Date Uounty of Ainemarte Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126 E Revised 11/02/2015 Page 2 of 3 Intake to complete the following: Y / Is us n LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y Will ere 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 is Ovate If private well, provide Health artment form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that applies Is parcel on septic orpdfilic sew 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 complete the following: Reviewer to complete the following: Square footage of Use: 7-5 0 �N LC C35Ci �- ermitted as: C L PaL, T� Under Section: Z 3, 2. 1«� C�fKK�s� carz+DYI Supplementary regulations section: Parking formula: ` - �O Required spaces: Y/N Items to be verified in the field: Inspector : Date: Notes: Violations: Y/N If so, List: ZVI© 2G(Z-►3D Cluoy�, fola) Prof Y If so, ist: �_. Vari7eej: Y ,` If so, st: SP's: if Ifi,2st: �. Clearances: Zv 7—Sd Zvl6 � U 2© S-b SDP's o Z o 2 fo - 5 zoo -O 2 2007-0 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 E Z N 7_% l Z [County application name and number] was provided to [name(s) of the record owners of the parcel] and Parcel Number manner identified below: QHand 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 J V1 l I 0 h-5aY11, 3J-0 V) C t O [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 6 1 1 i_/ �L�, 1T to the following address: Date 1101 VA [address; written notice mailed to tlfe owner at the laseknown 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 1/411 C,0rd Print Applicant Name M��� 1)111 , 10!5 Date t, �� M j J �. �� �� � � S� --,� � ��� `�- ..