HomeMy WebLinkAboutCLE201900285 Application 2019-12-17APPROVED
a Albemarle County
iiul I; / DevelopmTt Department
r� — f 1.—I
3WN13423UF1�
-ApIpliCal en -for Zoning Clearance
CLE # C�� I -- ZS
OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS Check # Date: �2 2
Receipt # Staff:
PARCEL INFORMATION q n Tax Map and Parcel: ra(1 ®(j Existing Zoning F p vt
Parcel Owner: X(—
Parcel Address:(_ CityCk0 �U Vl1(fStateVQ fa
(include suite or tlo ZtVD W
PRIMARY CONTACT
Who should we call/write concerning this project?
Address: ��ll City
Office Phone8h Cell#
APPLICANT INFORMATION
X
State
mail.
Cbfyk-
Check any that apply: Change of ownership Change of use Change of name
i e
g New business
Business Name/Type: e'- C"- 1 y �� i (11� Sn � n'
Previous Business on this site
Describe the proposed business including use, number of employees, number of shifts, available ar1king spaces, number of
vehicles, and any additional information that you can provide: { prndt)ta..ste? 5 q -� r�C3i lr-- - -t-
- - - v-, • appluveu, i, you cnange, intensity or move the use to anew location, anew 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 a urate 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 J 10 l�
PrintedL _aQl �`rt �O
APPROVAL INFORMATION
[ ] Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-45 11, xl 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 4ZI6Z j
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 1 1/1/2015 Page 2 of 3
Intake to complete the following:
Y
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y
Will there 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 �pu�bliwater?
Is parcel on private well ' t
If private well, provide Hea rtment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that app
Is parcel on septic or ublic 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 #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: I� 5 I Y
Y// N /r
Permitted as:?�Gj ctij
Under Section: Z-YA r2-t ZZ. Z1
Supplementary regulations section:
Parking formula: l
12-00
Required spaces:
Y / N
Items to be verified in the field:
Inspector:
Notes:
Date:
VioVs:
Y/
If so,:
ZUIU�zoog_ l`�9 ��- ��-�
Proffers:
Y N
If so, List:
Z — D 2-- v�
ZL/ I t2 z 2 fq- Cy Y-
Vari tm
Y
If s/N 7st.
Y SP's:
/
if ist:
Clearances:
?eft-rd0,
ADC -12-0, 3, Z& 2-35
2y1S•-2i, Pr1,2 —3-2
SDP's
L G
Revised 1l/l/2015 Page of
CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
Thisforrn Must aCCOmparr), zoning applications (Home Occupation, Zoning Clearance, Zoning
Administrator Determinations or Appeals, Sign Permits, Building Permits) if the application is not the
o",ner.
1 certify that notice of the application, c✓� jf /t/ ����C� /
[C unty pplication nam and nu�yn¢ber]�
was provided to C j� �� (t cat r o ecordd of Tax 4a
[name(s) of the record owners of th�parcel,
p
and Parcel Number 0J5 " -t• deliveringa cop
y of the application in the
manner identified below:
D>7<1 Hand delivering a copy of the application to
[Name of the record owner if the recor caner is a
person, if the owner of record is an entity, identify the recipient of the record and the recipient's
title or office fo that entity]
on _
Date
i
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]
Oil
Date
to the following address:
l aaaress; wntten 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 Apphean
Print Applicant Nam
Date--
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