HomeMy WebLinkAboutCLE201900166 Action Letter 2019-08-05APPROVED
by the Albemarle County
Community Development Departs,
Date , )r-T
Application for Zoning Clearanc
CLE# ao1C/ O014,4,
OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS
Check # C.C/ Date:,' _(c ' Iq
Receipt # Staff: ,-
PARCEL INFORMATION
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Tax Map and Parcel: d �p CC_} (' TD(�i\, Existing Zoning��
Parcel Owner: f' aEA1% C71 j�c'
Parcel Address:) %A00 Rxc) _)�IGY City Charloj�, Re_ State \JrSl- Zip 22gOI
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project?ykCA-C>y
Address : l U, 2 g C->f zve!_% M + l \ �,8 City �L �q State 1%+ f Ck ti Cl ca Zip Z -o
.01
Office Phone: ( ) t A Cell # aA-BqZ&-;7a-x # E-mail �raciis� (924(0 �+�sa;n}
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use _%Change of name New business
Business Name/Type: It c*-,i -EJo
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:,��-)�
CAUSt.; in- - i
*This Clearance will only 6e valid on the parcel or which it i 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 reo the conditions of approval, and I understand them, and that I will abide by them.
Signatur Printed CI a_AA i(P.�/\f��''j�
APPROVAL INFORMATION
Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-45 11, 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 1 Date C)/
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
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Revised 11/I/2015 Page 2 of 3
Intake to complete the following:
Is / u Is 1-I, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y i `ttf 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 ublic wate
If private well, provide 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 septic or ublic 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 #
Zoning to complete the following:
Reviewer to complete] the following:
�/ Square footage of Use: 1 , 000 Sir
Ql N �% 1
rmitted as: ReiI I — GCi��,, ( (°t'+�� 1
Under Section: 2-5. L , I
Supplementary regulations section:
Na��e
Parking formula:
s 1(c f icf, 5,5 s/uCCSP06V J i-
Required spaces:
SS
Y/N
Items to be verified in the fie d:
Fa 5' k ,' o-) S (/,t'C
f
Inspector:
Notes:
Date:
Viola 'ons:
Y /�
If so, ist:
Proffers:
If so, ist: i
vole
Var' Mee:
Y /N
If sly"
SP's:
Y / N
If so, List:
f1/o�c 1}�PI; Ca61e
Clearances:
LLf Z019 Illy
SDP's
SDP's
OP 0000 17-S Fasro, s vA,e Ma It
SQP Ig79 -i Ra+el, .
Revised 11/1/2015 Page 3 of 3
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