HomeMy WebLinkAboutCLE201900235 Application 2019-10-16�J;L. c j
Application for Zoning Clearance
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CLE #1 ��E zees-z3s
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # Date:
Receipt # Staff: 1"1/l.L
PARCEL INFORMAT m !�
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Tax Map Parcel: �/ D /&
and _e _ / Existing Zoning V)
Parcel Owner: ' (, Al,) 1.
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Parcel Address: � � C ty / � lh7 State
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project?__r �� l
Address a / Rl ud- City c . V VA � ��,-
State Zip"
Office Phone: lt> r Cell # 5 ! " , /6 ' 6 ` 5a E-mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: '% 1 t"G (,2`_e(, l- b
Previous Business on this site
Describe the proposed business including use, number of employees, number of hifts, available parking spaces, number of
vehicles, and any additional information that you can provide:
*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 accura�o the best of o/wwle ge. I have read the conditions of approv 1, and I understand them and th t I will abide by them.
SiSignature
g PrintedL�
APPROVAL INFORMATION
[ QApproved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, xI 17.
[ ] 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
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
& 2- C�( � - OZ6 M Revised 11/02/2015 Page 2 of 3
Intake to complete the following:
Y /
Is us LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y /
Will Ore 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 water?
If private well, provide Ha j!t , went 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 p �c sewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit # 13 Z N' -Oz6C (
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: 2 j 7 g c
YIN
Permitted as: M 4 c
Under Section: Z.5 # Z i ( --+
Supplementary regulations section:
l r
Parking formula:
Required spaces: I--- nCees
Y/N l I
Viol ns:
Y /(Z.
If so, ist:
Proffers:
Y / N
If so, List:
Z kA 2007 -DZ
Vari,jan,r e:
Y /(NJ
If so`` --fist:
SP's:
Y /
If so, List:
Clearances:
qf Klets,
V -203, zo(S - zqq, - z `t 3
SDP's
2 z"! 2 - Z
20t_-75,
-&T, 200-296,—ZeLf
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.
1 certify that notice of the application, CLE2019-235
[County application name and number]
was provided to BMC Robby Noll
[name(s) of the record owners of the parcel]
the owner of record of Tax Map
and Parcel Number #ouo000n0041 D 1 by delivering a copy of the application in the
manner identified below:
Hand 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
EE Mailing a copy of the application to Robby Noll
[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 10/16/19 to the following address:
Date
400 Locust Ave., Charlottesville VA 22903 Suite 9
[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 Applicant
Denise Childs
Print Applicant Name
10/16/19
Date