HomeMy WebLinkAboutCLE201900216 Application 2019-10-076,,7,9-7Q2(o3NwS �3 8 7o�3 T
Application for Zoning Cleara e►"'T
CLE #
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY o�
Check# Date: t
Receipt # Staff: C.
PARCEL INFORMATION
2 /'�
Tax Map and Parcel: 1 Existing Zoning co�W 0'1�'1 l�—�
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Parcel Owner: [a-4 J! r (�•�r Joek1c)us en -Tic, 1 &q A � n � t v C!I t.
J?I`' G�G %iG ; 2C". TOP
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Parcel Address: y 5 C�sT I !� %�{/�City C�/a�3fFSu fL[E State V A Zip zq®�
(include suite or floor)
PRIMARY CONTACT
Who should we call/write,-concerning this project? .Jf1 M1 f t4V o"� s-
Address: 5-5- `BCC 1!16 P(4c1: >o l7E Ncity(to °6,v !l4e State SG Zip �601
Office Phone: ye,- -/23�Ce11 # �'& _ Tgax # E-mail ieJ-i/Is@
V G /caS1' � u"ds7i'Pc �i✓�1
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: 57-P 2.-r ig g,-, J?eT,I T n)F u If— 61ry to P6
Previous Business on this site_ 12ME,CIC.r^1J 641-46 1, _Sd / Zy
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: : - G e #�e�} • p.t� ��
A JJ1,� un. 3`�--
O rl+ edic c Pi 44- / (Or 09,1.M %>a�P>IC. nrSlU�J *This Clearan (�
e 11 only be valid on the parcel for which it is approved. If you change, intensify o move the us o a new location, a dew 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 accur e o the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed_ Jolmes k E,a-,s
APP VAL INFORMATION
[ pproved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, x] 17.
[ ] No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
site pla
[ . is site complies with the site plan as of this date.
Notes: 557 A0 Z 003 jZq
Building Official Date
Zoning Official Date 10 �l
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
to-?-(`�
Z l6 Revised 11/1/2015 Page 2 of 3
Intake to complete the following:
Y /
Is e LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y
Wi t 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 o ublic wa
If private well, provide Hea`I artment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic or lic sew
Reviewer to complete the following:
Square footage of Use: L/
Permitted as:
Under Section: Z
Supplementary regulations section:
Parking formula: i / ►` �v S V r 206-5 I Z5
l 2.Oo +1
Required spaces: c 7 0 � 1
Y/N
Items to be verified in the field:
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit # Inspector
Y / N Notes:
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to comnlete the following:
Date:
s:
Y
ViEst.:
Ifs
Prof s:
If so, 1st:
riance: ��/
Y/N C
so, List: / r �V �� `a`�ic119
SP's:
Y 61st:
If s
Clearances:
SDP's
2d��
Revised 1 1 /l /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,
) jj [County application name and number]
was provided to \In � ( e r^ l -'A d e Po J5 o, j r, G the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number
manner identified below:
by delivering a copy of the application in the
Hand delivering a copy of the application tojer L 4 ae- W4114(14r, -TAe
[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
[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].
Signat e f Applicant
Print Applicant Name
Date