HomeMy WebLinkAboutCLE201900142 Application 2019-06-22the 4%,lbernarle County
Departmeni
Application fo Zonin learance
CLE # (�
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hRcicPP
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # 7 3 Date:
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: (DUQ - Cl0' Existing Zoning A
Parcel Owner: 1`�11�E.rw� �' LA,(d Ue,
Zfo t Za.,� t /
Parcel Address: 4ctl D M lhp a C. Jl 2c 3 ��% City (fk&; I6// *mvJ/>!r State t 1tq Zip 2.2 ( (
(include suite or floor)
PRIMARY CONTACT jt
Who should we call/write concerning this project? 21+e0h*n {y�, ►,lE I T-aV,,
Address:lqS brive Cityff,SgV34f State Zip,72 //
Office Phone: (W ) q7l?-9191 Cell # Fax #, 22�-3' 1a E-mailia 1aK�[�r,�atiy
APPLICANT INFORMATION
Check any that apply: Change of ownership Chnange of use of name ✓ New business
n—Change
Business Name/Type: (tv t4 Pk. siCi &ws L-°ru ,� o n �a� ty� l �s �� . ci Y 1Cr �; c l� %%7��"cw� ►,: �cr, �;
Previous Business on this site 7 - -12,/ .5;. �� �.��se' ��3�, i��CY �lae✓
Describe the proposed business including use, number of employees, number of shi ts, avai able parkin spaces, number of
k�
vehicles, and an additional information that on can provide: is 4h xe; r `l;,rr ; ��J&
twx,
*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 accu e to the best of knowledge. I read the conditions of approval, and I them, and that I will abide by them.
}my �have (understand
Signature Y 1 V�a ('_ Printed
APPROVAL INFORMATION
[ ] Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, 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.
S Ot') Z O 16
Notes:
�-
Building Official "' V , Date o /f
Zoning Official Date
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
CC_WM
Revised 11/02/2015 Page 2 of 3
i�217-Dfty30
Intake to complete the following:
Y / NO
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y
Will t 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 public water?
If private well, provide Heat Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic 011 public 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 proper Permit.
Permit #g,2Q19-01Y,30 AG
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: 6/ 3 3 U 1p
N y�
iitted as: AAY'ki �%(1s, d 14��� 5le�,g ffiCe
Under Section: Z 1-1, 2,1 (2 2) L
Supplementary regulations section:
Parking formula:
Required spaces:
3 lea 5 q ,� 3 Qr.�Ge3
Y / N cLuu q Livi e-
Items to be verified in the field:
Violations:
Y/IN
If , L'
Proff rs:
Y/-L
If so, ist:
Variance:
Y Ulf
Ifs st: ^�
SP's-
Y
If ist: ,
Clearances: r.
SDP's '-War-rwe c
Revised 11/1/2015 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, 2e.2w%. LL
/ /} [County application name and number]
was provided to 4" (�j.ru C� l� �,a kX `l the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number by delivering a copy of the application in the
manner identified below:
dHand delivering a copy of the application to A17,4we'l"
[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` Vic".-lq
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 9 L
Print Applicant Name
': �. "f !? r, , gal 9
Date