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HomeMy WebLinkAboutCLE201900119 Action Letter 2019-06-034PPR,,-) }EI J Ley the Albemarle County Community Dpvr.-lopmen.t Department n.;z;•a Application for Zonin Clearance CLE # Iml - 6C if Zo 19 _ 119 ,. OFFICE USE ONLY Y �_ / G PLEASE REVIEW ALL 3 SHEETS Check # Y) Date: {?", Receipt #'I Staff: PARCEL INFORMATION Tax Map Parcel: 4s — QQ -14 k o 0 S C and Existing Zoning Parcel Owner: 1 Parcel Address: V7 590 K i 0 m � � Q Vtk 1- City cy'I'V �C .�wr) (� to e Zip (include suite or floor) PRIMARY CONTACT t4 eKe_y-p_, Who should we call/write concerning this project? K/(�' �� Address : 1750 R% O �k` l? `kr City u'W1dqie_S1) Mate VA- Zip Office Phone: (D`f 590 5q © Cell # qq 3EO 340 Fax # NA- E-mail _�"lIAACowttCS ?.P_' 5MOL` APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business Business Name/Type: T tLi� rck LUC-1 l Previous Business on this site `�Q b 1 eS L A-C- Describe the proposed business including use, number of employees, number of shifts, available parking spaces, nufnberr�of vehicles, and any additional information that you can provide: YSEA-0,A] n-y-A--i C WOO �1NLfD�Ocjte�.d— Id anti ►mac *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 1 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 best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them. etttootthe Signature '/� l PrintedQ�{ APPROVAL INFORMATION P< Approved as proposed [ ] Approved with conditions [ ] Denied [ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-451 1, xl 17. [ ] 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's ��1/"y1 Date ( Z 0 l 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 it/l/2015 Page 2 of Intake to complete the following: Y / Is us LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y / Wil 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 ublic If private well, provide Health epA�ment orm. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that appli Is parcel on septic or ublic sewer. Y/N Will you be putting up a new sign of any kind? Sign permit. Permit # If so, obtain proper 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: I 0 / e itted as: t n 1' � G Under Section: 25 • Z ` ( Supplementary regulations section: VM Parking formula: 1/2- Cc Ns�-- Required spaces: It/ Item be verified in the field: Inspector: Notes: Date: VioVI*ns: Y Proffers: V� o,Ift: so, List: 7,M 2� S W 1 ZMA -7 oat ZO 7Y—A I y 8- Variance: Y/N If so, List: S 's: 6/N Aso, List: SPZooq 3) Clearances: C 2 � f � S,p SDP's 05 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] 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 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 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 oc�,t.- Print Applicant Name Date '�� 300 �,a.J� � Nov - Roo ,�Y,p rox crna:�