HomeMy WebLinkAboutCLE201900190 Action Letter 2019-08-26APPROVED
by the Albemarle Cour.N
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Application 'for Zoning Clearance
CLEF �)—C) CA
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY f
Check # Date:
Receipt # Staff: Rk'- -
PARCEL INFORMATION
Tax Map Parcel:�` - Existing ZoningVJGf�/
and
Parcel Owner: Gve2,.lnr p 1 `Jc°
ParcelAddress:37c) -,,eY-.b';cv ba"jo City 6VvyAT ,%Yk State Ll Zip vl
(include suite or floor)
PRIMARY CONTACT 7 n ��
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Who should we call/write concerning this ppro/ject?
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Address: c�. �.9 5��,�cb'4 � City �5 � Statey/� Zip 3-7,
Office Phone: (S ) q (,a Cell # q3-�1�16-8536 Fax # Sgo-1 i -63d1 E-mail 54LLr N@ 1�v�' �P�-Y �b
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name business
rNew
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Business Name/Type: ��VJ �v. u .� ,� ��ro. �J�� Oy 04, "T a 7ta�h r\cl
Previous Business on this site G�we 01C R110-e-5' 0, Icc•41�9
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
Z
vehicles, and any additional information that you can provide: 7P,,ctdc��F�
T�
*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 o ner'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 nowledge. I read the conditions of approval, and I understand them,and that I will abide by them.
A54,
Signature Printed • !T Y�`ft^
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, x117.
>4No 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 1�1114
Zoning Official -7 Date 3 1 2-0
Other Official Date
County of Albemarle Department of Community oeveiopment
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
Revised 11 /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
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 o ublic ater?
If private well, provide Healt rtment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that ap
Is parcel on septic o ublic ewer?
Y N
Will be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y
WiQtere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the followin :
Reviewer to complete the following:
Square footage of Use: q /' S /ll
IY / N P j✓(e1n�
rmitted as: �ui
Under Section: Z `
Supplementary regulations section:
N�
Parking formula: i A Ov S-t tee I�A I +-ec/
Required spaces: 14
Y/
Item a verified in the field:
Inspector : Date:
Notes:
Vio ions:
Y/N
If so, List:
NQ-� e o� �� �F
Proffers:
Y/N
If so, List:
zM a i N R D
(o
1� 9U
l s
1 F$¢
13
riance:
�/N
so, List:
VO 'R�iN �
's:
Y/N
f so, List:
A0,1e6le
vrg ►��b Hl
Clearances: Z 8$
LE
SDP's
SDP �Ut�3
3
4- 3
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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, Nb Cf4- , -C A
[Co ty application name and number]
was provided to C`> r rb-4cd �t L LL the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number �o -bi -b,A by delivering a copy of the application in the
manner identified below:
QHand 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
Mailing a copy of the application to AV O" ors �,�.� ,
[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 � — n� - 19, to the following address:
Date
`k11p N"", A S.,- e ,J \JA Cpa1(),�L
[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].
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Signatur o�f�Applicant
Print Applicant Name
Date