HomeMy WebLinkAboutCLE201900121 Application 2019-06-11APPROVED
by the P:ibemade County
C:t�'llnity L�ezilrY,� f nepartment
Application for Zoning Clearance ct���,��
LL pt :11.(yy
PLEASE REVIEW ALL 3 SHEETS
OFFICE USF,ON Y
Check # SDate:
Receipt # Staff:
PARCEL INFORMATION C�
Tax Map and Parcel: Existing Zoning
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Parcel Owner: (L) 1 w 2- 07 `
Parcel Address: /Z /S 1 A:1 City C-4('V'114Pwl yf State L/A Zip ZZ�/
(include suite or floor)
PRIMARY CONTACT
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Who should we call/write concerning this project? E I" a5 N rgy QJo. Ccis�'l t / U
/
Address://93, Sew6ny1J 'T�'o" City Ckay t�Te5V1 to State V A Zip ZZgC))
Office Phone: ) ZZ(o—�J Cell # r{3c( T31 3@ ( Fax # E-mail' - - � "
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.J _ N . 0.uEot�patt.l^,ViN�
APPLICANT INFORMATION
Check any that apply: Change of ownership _ Change of use Change of name i, " New business
Business Name/Type: ly)' Cv_* r'eys\'r L—LC
r
Previous Business on this site �P ciy
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: -e j
X in 11 e Ko T t, VA-ZZq6
VVIV 6 .r <tiz e S
T is Clea7rancelvill only be valid on the parcel f4dwfi—ich 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.
SignaturePrinted
AP -'.OVAL INFORMATION
[ "f 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 /Cf
Zoning Official Date �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
V4I•WM
Revised I I/1/2015 Page 2 of 3
Intake to complete the following:
Is !
Is us LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/N
WiI 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 c wate?
If private well, provide Health ment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that ap;i��
Is parcel on septic or
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: 5 1 S O 47
N itted as: ALAO Qefefr SkeD( fUdie 6av-colr,/
Under Section: 22, Z , 1 02-
Supplementary regulations section:
Parking formula: (f 1
Required spaces: (
Y // N -
Ite�s-t�b be verified in the field:
Inspector
Notes:
Date:
lations:
rY N
so, List:
Z k" 2 V 1 � - .7� Y , 7011- ZD ,
Pro/ff s:
If /`
If so, Est:
2 CC)
riance:
/N
o, List:
0-06
SP's:
Y/N
If so, List:
CIea rances:
SDP's
20l6- 7
2-a1_115
Y,
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,
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]
m
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 App icant
Print Applicant ame
6(0
Date
C Lf 20(?- 1 z(