HomeMy WebLinkAboutCLE201900074 Approval - County 2019-05-30{.iPPROVEu
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Application for Z-06 � T;learanc
CLE # ��=,
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # Date: U -19
# Staff:
PARCEL INFORMReceipt
�j,TION U�% O Existing Zonin g ���
Tax Map and ParcParcel:
Parcel Owner: C 7 - L L L
Parcel Address: 6j Jr, K / l? <'ACity (ld 44 107T- o 14 Zip
(include suite or floor)
PRIMARY CONTACT l
Who
should we call/write concerning this project? {��d
Address E: Cityf �� State Zip'Y -
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y3 q-43 -1 // ue Q 1VI
Office hone: ell # T 3Y`�(>O (%/.SZ Fax # E-mail &/^
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APPUWAtqT INFORMATION
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Check any t at apply: Change of ownership Change of use _Change of name New business
Business Name/Type:
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IriSa l(.e ` (,LDS LLv
Previous Business on this site ' 16 U \
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, numbe of
vehicles, and any additional information that you can provide: -__L6G A1v1Q b esi rf Si If�"`S7�71/P{� ��M —
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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 Zoning
Clearance will be required.
I hereby certify that I ave the ow 's per .ssion to use the space indicated on this application. I also certify that the information provided
is true and accurate t est of my e . have read the conditions of approval, and I understand them, and that II will abide by them.
Signature Printed / iT 0/!vim
OVAL INFORMATION
roved as proposed [ ] Approved with conditions [ ] Denied
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kflow prevention device and/or current test data needed for this site. Contact ACSA, 977-451 1, 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 /
Zoning Official Date Im
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
Revised 11/I/2015 Page 2 of
Intake to complete the following:
Y
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
Y 0
If so, give applicant a Certified
Will there 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 o is water
If private well, provide Health Depa ment form.
Zoning review can not begin until we receive approval from Health
Dept, FAX DATE
Circle the one that appli �'`�
Is parcel on septic publi seE wer?
Y 'L,"/
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y c
Wire 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:
DImitted as: J
Under Section: 95U,
Supplementary regulations section:
Parking formula: I
L_
Required spaces:
Y /(N )
Violations:
Y/N
If so, List:
Proffers:
Y/N
If so, List:
Variance:
Y/N
If so, List:
SP's:
Y/N
If so, List:
Clearances:
Ct � gol�- I��'
SDP's
QVA 0 2
(IL - lL
Revised I1/1/2015 Page 3 of
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,
was provided to
[County application name and number]
[name(s) of the record owners of the parcel]
and Parcel Number
manner identified below:
Hand 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
[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
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
Date
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