HomeMy WebLinkAboutCLE201900240 Action Letter 2019-10-18Application for Zoning Clearance«""
PLEASE
OFFICE USE O j
3t� 10_7 f
REVIEW ALL 3 SHEETS
Check # Date: lI `ol
Receipt # Staff:
PARCEL INFORMATION . r
Tax Map and Parcel: ��� f� C� Existing Zoning (��Ulf� %�✓1-
,
Parcel Owner: O, t CA-rI t- S.
Q L 1 /_ \ / ,
Parcel Address: � lq �P0 t bl(�.�J 12pl �Jl'G City iIiLIGI,�.e �j/�'�t�kate V � Zip?� ��
(include suite or floor)
PRIMARY CONTACT ��� �.�Q •���
Who
should we call/write concerning this project? �
��
Address: 3 % 1 ✓Yl� ^. �u���( �I wlcity l.l(it,c we�sV./%4tate VA Zip7ZI
Office Phone: ( ) Cell # / �3�.3 LDS f E-mail Me-1 i C-C-ad K-Yl110l/f Cx_',, 1
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name winess
Business Name/Type: Ake` I -®o-h n I cam✓ ti-Vt C-e—
j
Previous Business on this site czc"4�
Describe the proposed business including use, number of employees, Dumber of shifts, available parkin spaces, number of
vehicles, and any additional information that you can provide: 5 (� rpl Ci g n(,L_-et,.k_Lp
CZ-rS i/11f
*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 t e best of my knowledge ave read the conditions of approval,and II understand them, and that I will abide by them.
Signature — Printed , t'/ e_[ % GOL (4 ►.�
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, x 1 17.
'P<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 f, 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
Revised 11/l/2015 Page 2 of 3
Intake to complete the following:
Y
Is Al Ll, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y lN1
Wi 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 or ub '~water?
If private well, provide 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 septic o pu 7Yrsewer?
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 #
Zoning to complete the following:
Reviewer to complete the following:
uare footage of Use:
2 ® O.2— Sr -
Permitted as: of �t
Under Section: 24, Z • 1
Supplementary regulations section: N/ A
Parking formula: \ 1Ice a j f
Required spaces: 6
Y/jN)
Ite be verified in the field:
Per svF
Inspector:
Notes:
Date:
Violations:
Y /(N�
Ifs ist:
yo�
Proff s:
Y /
If so, ist: No- to
Vari ce:
dN
Y /a..J�
If s ist:
, /�a
SP's-
y
Oist:
If s ,� Vo lk
Clearances:
�►e ��►°- � �
SDP's
5A1° I q91- P« fps 0��C
�.
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,
was provided to "� Htvu —
[County application name and number]
[name(s) of the record owners of the parcel]
the owner of record of Tax Map
and Parcel Number 7 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
/mailing C.1kzkA
a copy of the application to 41-IX4�
[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].
WSignatuZreLof Applicant
Print Applicant Name
l0/'7/Z<GIq
Date
I
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