HomeMy WebLinkAboutCLE201900270 Action Letter 2019-11-21Application for Zoning Clearance
OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS Check-Ir ZDate:
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: ALO I fy) n Existing Zoning ' - n lj t• t N. , e '
Parcel Owner:__
Parcel Address: L.>�� -, + c,f M ��L.I+��'� City t �'q� Lt t!c„ �ryState `,/ Zip,
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning
this project? �
Address: - Y`t'_` �r `�i 1" Ci v t I State �`� ` Zipdt�-f
Office Phone: (_) Cell # E-mail 1�C`�� ►'K� �1 ZL�v1
►C r_-D C1
APPLICANT INFORMATION
Check any that apply: Change of ownershin Chance of use ChnnaP of Hama No.., ►,,.�;..
Business Name/Type: 1 Y^,an
t C� r>'1 —
Previous Business on this site
Describe the proposed business including use, number of employee ber of shifts, ava'lab a parking spaces, n m of
vehicles, and any ildditiolial.information that you can provide: jr-
rVCt l-� t
*This Clearance will only be valid o e arcel for which it is approved Ify u change, intensify or move the use to a new location, a new Zoning
Clearance will be re fired.
I hereby certify t t I own or have the owner's pe ssion to u e space indicated on this application. I also certify that the information provided
is true and accur e to the "est of my lcnowledg . I ve re the co itions of approval, and I understand them, and that I will abide by them.
Signatur nted
A(Ap
OV IN RMATION
roveas prop ed [ ] Approved with conditions [ ] Denied
kfl preventi n device and/or current test data needed for this site. Contact ACSA, 977-4511, x117.
><' o 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
E>--)
Revised I I/1/2015 Page 2 of 3
Intake to complete the following:
Y N
Is u in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
WillVerebe 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 public w ter'?
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 applies
Is parcel on septic or blic sewer
Y /
Wil ou be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y
Wil ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to comnlete the following-
Reviewer to complete
/the following:
Square footage of Use: ( ` J IC r-7-
'Permitted as: �� S �'► 0 �Ved� �'
Under Section: 25 6 . 2 ' 1 --i Z-3` Z' j
Supplementary regulations section: UJM
Parking formula:
IIZ,0 N (%Y/A)
Required spaces: 3 va-15 f" Z e"'(107cG5-
Y/N
Item e verified in the field:
Inspector:
Notes:
Pe ea r 5- e a MP e
0-1 s,
Date:
Vio Ino s:
Y/N
Ifs ' t:
Proffers:
y/Q
If so, ist:
Vari ce:
Y / �
If so st: A^ e
SP's-
y %�ii
If s�ist: ^ /0'1
Clearances:
SDP's
5,0 P zVo$ - 5
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,
[County application name and number]
was provided to (1 A� -,r-- 1- �f j,CD the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number ;` 7
,(� �, . l,C`•—)�-/—��`r i�1by delivering a copy of the application in the
manner i ntified 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 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].
=::;-c--,`, t Ica) � �t
Date
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