HomeMy WebLinkAboutCLE201900127 Action Letter 2019-08-05APPROVED
by the Albemarle County
A
Application for ZoninLy Clearance
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CLE #
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OFFICE U�S•>� �Nfi1C) Co.,
PLEASE REVIEW ALL 3 SHEETS
Check# (� lJ Date:
Receipt # i Staff:
PARCEL INFORMA I
Map
Tax and Parcel:lJbD Existing Zoning`.]
Parcel Owner: lc>M6 Ujb
Parcel Address: yff City dh,4d,+trS. i11e State �� Zip 0 9 d
(include suite J floor)
PRIMARY CONTACT
Who should we call/write concerning this project? ke//CL�
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Address: y �,,, RW City state�zip 2zcl
Office Phone: ( ) Cell # 31) j* :r-fax # E-mail , eIeyam S16 ybaLuc-
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name ew business
Business Name/Type: SUCH H(1 vS4 12nya L &4wlz
Previous Business on this site Cute F PC,, u" .I l•, ,s
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: �vs� i S'}„ t� VJ%� k<< ,.W- (►, ,�,yl ti e�
ID et~,�4e .{ w�- r 1i e n5e'-t .. 3e) + pr��z,a���c�s
e4y IM - —S
*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 th wner's rmi r to use the space indicated on this application. I also certify that the information provided
is true and accurate to the besl,,tE e conditions of approval, and I understand them, and that I will abide by them.
Signature PrintedT� ;
APPROVAL INFORMATION
.Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow 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 t� � 2C2
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
N
I�
C. V z
Revised 11/1/2015 Page 2 of 3
Intake to complete the following:
Y/N
Is us � LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y / N
Will here e 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 ublic water?
If private well, provide Health Departmen form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that app
Is parcel on septic o 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 emmnlete. the fnllnwino-
Reviewer to complete the following:
Square footage of Use: I 1� �
N
P mitted as:
Under Section: Z /
Supplementary regulations section: N 1 A
Parking formula: cI 26C sf wet
Required spaces:
Y/De
tem verified in the field:
Inspector:
Notes:
Date:
Violations:
Y/N
If so, List:
Prof s:
y/
If so, st:
ariance:
Y N
so, List:
Is:
Y N
so, List:
tuo-�e oN �� ca61L
Clearances: Z Q ( 5, 3
SDP's 5V e (q 9 v ( Q
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Revised I I/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]
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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