HomeMy WebLinkAboutCLE201900207 Application 2019-08-28Application for Zoning Clearance__"��
CLE # ��
OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS
Check #
Date:
Receipt #
Staff:
PARCEL INFORMA IO
Tax Map and Parcel: 61 Q—(���(��' �t;} Existing Zoning
C�
Parcel Owner: 44gg a)oop 2a000T1 LLC_
Parcel Address: a33 4*' eA,-uc- i vte gr>, # Z�► City C f 1 AZ LLI i ESvjLiE State
UTA Zip zZSo
(include suite or floor)
PRIMARY CONTACT
Who lq iZ 1 c-,-f p lzgsr, ill/
should we call/write concerning this project? ,i
Address: 11113 Zc AJSLLS rzV> City heart 2icl53klt( State
V '-1 Zip a�iJo7
Office Phone: (`S�°) g`IQ ZZc� Cell# 5�1()-aS9_0"/Fax# E-mail
AYYLIUANT 1NFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: C E r,�7aA L� ' t2 61 tiJ i A p2'r H u NT, c 1 (_L C
Previous Business on this site / /Vd'^ \7`1' ®(_ 1 V+C; Dou + C 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: t)2-FHbypr4 rrc np lc'f 159'r_t-1 i�;3'3A,r-c -- s?.,
F-1PLc\/lit S, a tl PAPK(hR 5Po 175 4P_6gDf DFr��f
*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 Jowlelge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed V fit/ DAv �) tCHft PP-S-A-)
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.
[XNo 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: A62 4AZ&,= tyxfb
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
L..
Revised I1/]/2015 Page 2 of 3
Intake to complete the following:
!WON
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 water?
If private well, provide Hea t 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 ublic sewer?
VY J/ N
►II you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit # %BQ 4m
Avo-
Y /(0
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
c.ui,uig w w►up►e►e tile iuuuwu►
Viola ' ns:
Y /6)
If so, List:
Varia ce:
Y / �ist:
If so
Clearances:
Reviewer to complete the following:
Square footage of Use: �O
Y} N / �zp
4rmitted as: � oT / Cie
Under Section: �� • Z • �. 2
Supplementary regulations section:
-!A
Parking formula:
I f l ?5
Required spaces:
� SPA �s
It //N)
Tte to be verified in the field
Inspector : Date:
Notes:
s:
/ N
f so, List:
os-2�
SDP's
Revised ll/I/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, 661 DO - 0 p - c, o - o2 -7-op
[County application name and number]
was provided to GAe2 `' pp �S L
[name(s) of the record owners of the parcel]
and Parcel Number
manner identified below:
XHand 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 Zg i1
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-. 'plicant
, 5ei� 'qld,] tL�P�t�<e/,1
Print Applicant Name
q/Ze/l y
Date
Parcel ID: 06100-00-00-02700
Parcel Assessment Data (CAMA) Last Updated On: 08/25/2019
Other Parcel Data Last Updated On: 08/25/2019
GIS/Mapping Data Last Updated On: 08/25/2019
CHARLOTTESVILLE
233 HYDRAULIC RIDGE ROAD
CHARLOTESVILLE, VA 22901
MME151,71
RESTROOMI � STORAGE
_1
RECEPTION
_EXIT
FRONT DESK
CONSULTATION
DR OFFICE
Fwdt l
Aid Kit
STERLIZATION
OPERATORY
1 -In vzl Q 1�