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HomeMy WebLinkAboutCLE201900191 Application 2019-08-23'APPROVED by the Albemarle County Communi , �-)veln ment Derartmeni Application for Zonin Clearance r m CLE # -�-� AY` �/Rc,1N�P OFFICE USE ONLY PLEASE REVIEW ALL 3 SHEETS Check # 'o-l-&300 Date: $ l Z Jlq Receipt # Staff: PARCEL INFORMATION Tax Map and Parcel: II � i � Existing Zoning )��1/ \� wy�� . Parcel Owner: �i e--, - , >Vr `\� ,ter, 5 Parcel Address: Sad-` �Qc'& k 6D _TP k F City - i L_0,5'J State zip P' 1163 (include suite or floor) PRIMARY CONTACT Who should we call/write concerning this project? 71L y AIA-c r Address : a, �3��5�: v�c,��1 City AAOC�'_`�n,.\ State U A Zip 347 Office Phone: �i9`ICs-3C>0, Cell# Y3119g6-b530 Fax #IND-`i`lSs ME-mai17AL1E,3@MLOPStkfPLY.CtN+ APPLICANT INFORMATION Check any that apply: _X_ Change of ownership Change of use C'nhang1e of name New business ir Business Name/Type: e w tJ s„M�Ty\�4 A,� l��ls.e K c�ce rJ� Ir�e�s ,,00�4 Previous Business on this site C���.e {2;�,�� i��. �� S S do L f of � Describe the proposed business including use, number of employees, number of shifts, available parkin spaces, number of vehicles, and any additional information that you can provide: eel"' / 35,.,,4)6-5c< // j�:� ys papa_k K, 0, *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 ermission to use the space indicated on this application. I also certify that the information provided is true and accurate to the f my kilo I . I have read the conditions of approval, and I understand them, and that I will abide by them. Signature Printed in A- �6Ijj��'Pv1 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, x 117. ( l No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing site pi . [ his site complies with the site plan as of this date. � � Notes: Building Official Date 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 Revised 1 1/02/2015 Page 2 of 3 Intake to complete the following: Y/N Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y Wi there 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 lie water? If private well, provide H 1thTe arfinent form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that applie Is parcel on septic ublic sewer? Y Mau be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Y/N Wil ere be any new construction or renovations? If so, obtain the proper Permit. Permit # Zoning to lPtp the fnllawinu- Reviewer to complete the following: Square footage of Use: 6 ( j Zoo as: 6V k4t'yt44 5k�eS Under Section: -Zcf, c z-, ( 6�) t` Z.Z, L M- 1 Supplementary regulations section: Parking formula: PtV 5W N � 7-oz Required spaces: 6�- v) &,— Z-Z sy4rt act 5 rtC Y/N Violati ns: Y/ Ifs , st: Z(/(© 29O — Z( 2-C ri�Jc P�' Proffers: Y/N If so, List: ,t z A 2 wt{ wVI 613 7riance: Y/N If so, List: SP's:— I' If st: 12 Clearances: �r 5 OL4� e14�-, SDP's /� 9 7- ° z (5 -4' ,6 —i ( o Revised H/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, ;?�cNo ��C,,r l /� [ unty application name and number] was provided to 1 t to l the owner of record of Tax Map [name(s) of the record owneA of the parcel] ^^ 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 14— Mailing a copy of the application to C(e S [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 �-- Imo— n to the following address: Date VA x),qa [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 Aq/,,- -e A Prini Applicant Name Date fl 0