HomeMy WebLinkAboutCLE201900244 Application 2019-10-18N5(Sq('Z C13-7 L L( o0 V
Application for Zonina Clearance�y°e�t
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USEONLY (s.
Check # �_ j� Date:
Receipt # Staff:
PARCEL INFORMATION
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Tax Map and Parcel: OU OO - DO - Do - l2 3a0 Existing Zoning ( L' S�
Parcel Owner S O c • L t,ani GG{
Parcel Address:+Q Alke- nn 6 , LA City _C-fn 0,y l u{kt S u W C&tate _ Zip 2'"o i
(include suite or floor
PRIMARY CONTACT
Who should we call/write concerning this project? _ �t/t Sfivt G,[.1t�U
Address: S044- , [6-e�eu4 L SG— u6q,-r— City C.tr•av1cgtt�Sy+ltLState \/A Zip 27'90i
Office Phone: $3 f3 I "t i B43 Cell # La O3 3q 1 SC,gi Fax # [{3+ q-i.5 UO3+-mail Ctny'I C,y1L C
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of us—e----1.7 Change of name New business
Business Name/Type:._ AC AC.., — 9AS-K %.Uv%iL.
t
Previous Business on this A C.A-L - S 'thL C_fAA-t•f—t-
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: j��y5 �CCt. l-1hC.t�Gt to V C -L.4 A C
*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 he 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 of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature _ Printed _ CA,,N
APPROVAL INFORMATION
[ ✓j Approved as proposed [ ] Approved with conditions [ ] Denied
[ j Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, x117.
[ ] 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 /4 f
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
Revised 11/02/2015 Page 2 of 3
Zol�i- DZ6c� j
Intake to complete the following:
Is /
Is UsOl, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y �N %
WilYllrere 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 r public water?
If private well, provide Hea ent form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that a
Is parcel on septic(or public sewer
YN
Vyou be putting up a new sign of any kind? If so, obtain proper
Sign permit,
Permit # A 2 a q- OZ 6 0 q- S
Y/N�
Wil there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use:
I/ N f O(`�`�
ermitted as: ej(q / c,
Under Section: 25,2 , I IN-:) 2 3, 2" (� Z
Supplementary regulations section:
Parking formula: 2 00 V [`-7
Required spaces: '
CC C-e S
Y/N
Items to be verifietd in the fieldL .
S eq (-e 'k -9 k eS ky �f
4DV?l1atn of" qt 410
fah_ VfMfls r to wti l ( Fish &44 —�
Inspector • Date:
Notes: �- V,
4k o c , c2S d Co �r2'vr(2 �° Ih
Viol ns:
Y /IYJIN
If so List:A
ers:
so List:
C/
Variance:
Y/N
If so, List: �
P's:
/N
so, List:
e C•e
Clearances: -
ZOC _ I y
SDP's 5,0
n `q 5�_ YC(
2na-84t, -23, 20�
efi-E
s Y2
cAIl1, use
Revised 11/1/2015 Page 3 of
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, _ A ptt cCoh o-.1 -Gv-- 7-0'A"" q
[County application name and gjuu' fiber]
2� a Assoc—
pJAAMto AAA-vv%
was provided to l.. eA't-tt. ~' Li 12 C— p * owner of record of Tax Map
[name(s) of the record owhers of the parcel]
and Parcel Number �o l 6b - bn -UD - 1Zg o0 by delivering a copy of the application in the
manner identified below;
0 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 a copy of the application to 1->k,cLAA-cY1 rD W'ii GS
[Name of the record owner i 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 1 I cl to the following address:
Date
1 a313 WC-1;7t $yoAck St. akem AkC4n , VA 23o (oy
[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
Cam► Vi Sni V, c...1U
Print Applicant Name
Date
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