HomeMy WebLinkAboutCLE201900192 Application 2019-08-29Application for Zoning Clearance ALE zG-lq_
CLE#_;LL)�C1-10
PLEASE REVIEW ALL 3 SHEETS
PARCEL INFORMATION
Tax Map and Parcel: TMP 78G0-00-01-000A0
Parcel Owner: Shops at Riverside LLC
Parcel Addres� Ci '5hAas C f
s:
�v� y
(include suite or floor)
OFFICE USE ONLY
Check # Date:
Receipt # C' Staff:
Existing Zoning NMD
e�A State zip d 911
PRIMARY CONTACT
Who should
we call/write concerning this project?
Address :_ I ��} �f- �1 � � F City _C_k^ A'yt' Jde State �Sz lk Zip cW
Office Phone: (_� Cell # C G — � 10 Fax # � D1i'�-�J,,
E-mail,} ► � �11.1 �i .nrn1n,...,..,
APPLICANT INFORMATION mU"�`CLrn
Check any that apply: Change of ownership Change of use
g Change of name New business
Business Name/Type: _r 'K 0
Previous Business on this site 1'
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 ovide: c `
- 1
*This Clearance will only be alid on the parce for which it is approved. If you change, intensify or move the use to a new location, a new Zoning
Clearance will be required.
1 hereby certify that I own or have the owner's permission to use the space indicated on this application. 1 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 __)�Q1(\, ,q V O \ rr J , 0 '1.
APPROVAL INFORMATION
[ ] Approved as proposed [ ] Approved with conditions
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-45 11[ x 1 Denied
17.
[ ) No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
pla
n. .rThis site complies with the site plan as of this date.
Notes: P 7,C( -7 L
Building Official 1
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
13 2 41 �— 1)(9 7 5 Revised 1 1 /02/2015 Page 2 of 3
-� �V111VIVtc the lollowing:
's us in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
Wil re 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 p is waler?
If private well, provide Heal
nit form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that 4ap;�,Is parcel on septic
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
�Y n N
ill there be any new construction or renovations?
If so, obtain the pro er Permit.
Permit # f� e 'V- 0 '77
tk4,ehjr v c;'
Film to complete the following:
ions:
ist:
V(d " 2"p
Vari ce:
Y /IN
If t:
Clearances:
lob, 2-0[9 Si
Reviewer to complete the following:
Square footage of Use: Z� Y 6
�eN
mitted as:
Under Section: t? fy
Supplementary regulations section: Pal 1 Zo(s-D
Parking formula:
Zb'p � coNt�'hPtiGi�i
Required spaces:
Y / N 5 C ®�
Items to be verified in the field: r Zoo — 6 2
Inspector:
Date:
Notes:
,V/N ZPA 20l6—!?
If so, List:
Z-Nl�k Zv�s—a3
SP's:
If
[fsO, ist:
SDP's
Zdl7-6�. Zol7- � b�
Revised I 1 /1 12015 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.
m
`I certify that notice of the application, � k,_ l ) I 9 � S
[County application name and number]
was provided to
[name(s) of the record owners of the parcel]
and Parcel Number
manner identified below:
the owner of record of Tax Map
by delivering a copy of the application in the
Hand delivering a copy of the application to
[Name of the record owner if the recor 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 IN U
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:
tauumbs; written nonce maueo 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].
CI
Signature f Applicant
Print Applicant lame
NUP,ul;t WR cC,1�1
Date
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