HomeMy WebLinkAboutCLE201900205 Action Letter 2019-08-28APPROVED
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Application for Zoning Cl arance
CLE# � �G��OZ§
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OFFICE SE ONLY
PLEASE REVIEW ALL 3 SHEETS
Check # (L Date:
Receipt Staff:
PARCEL INFORMATION
Tax Map and Parcel: YYIw Ll152 L& 5 P\ Existing Zoning C7 l l
Parcel Owner
Parcel Address: )Q Gt Yt'� f l'f Ck Q City iW(A� —Sy&QState -fy Zipc j�+
(include suite or floor)
PRIMARY CONTACT
Who should we call/write�cooncerning this project?
Address : J � �M t mxld lk r YX' In City U�� CSi \-S, ��Ji Zip 2�j
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f �(& y�State
Office Phone: 3i -� (� Cell # '7�7 F9-Z ax # '1 S4-13-� PE -mail KU- LL '- AL)TyAAwQ j~, K
CZ:)Q V..E-LXVJG.Ccrn
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: A��`� Affn �k< I.c r&,1(1Cti
Previous Business on this site �� 5 N-ca 6� ��ywws t�C
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: t,S ne!-1 S
CJLfucm lV.ttrrut 5'(3t'tycF" o-
*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 accurate to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature 3 k --� Printed
— U . ,
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.
[�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 Z ZG j
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 11/02/2015 Page 2 of 3
Intake to complete the following:
Y / �:.�'
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y 6
Will 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 ublic water.
If private well, provide Health form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that ap
Is parcel on septic orVublic seweie.
Y
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y
Will t ere 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: I + J
Y/N /°)r
ermitted as: V r�' er
Under Section: 2 J ` 2 . 1
Supplementary regulations section:.
/�--( /4-
Parking formula:
1 IZoo kj5 F
Required spaces: 2 f e w1� �hC r
Y/N J
Items o be verified in the field:
Vrc�lt, 6/e r4�ci
Inspector : Date:
Notes:
Violons:
Y /(N.
If so 1st:
Proffe s:
Y /�T
If so, ist: /Vox
Vari ce:
Y/
If so, ist:
,�1/0°tie
SP's-
Y/
If so``, ist:
/Vv�zrz
Clearances:
LE 2,0' 5'
SDP's < n j y 9 q 125
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, U l ,c��—
[County application name and number]
was provided to the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number— A,� , �_ ( CL� != by delivering a copy of the application in the
v
manner identified below:
11�j Hand delivering a copy of the application to�Q P.
[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]
on2lo Q1;),o��
Date
Q 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].
mil!
ignatur of pplicant
Print Apoicant Name
) x-A I'9
Date
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