HomeMy WebLinkAboutCLE201900288 Action Letter 2019-12-26APPROVED
by the Albemarle County
- �trtn,rtt„ttr
Applicatioa for 7oi rout L'ff fiifance
PLEASE REVIEW ALL 3 SHEETS
OFFICE
Check # Date:
-
Receipt # 1'92 staff:
�---------�-- --- -- - - —
PARCEL INFORMATION_
Tax Map and Parcel: 7'�& -/y� _CQ — Existing Zoning `
Parcel Owner: 1
Parcel Address: � � � 1� City � 6-jo� State _--_ zip
(inclu a suite or oor)
PRIMARY CONTACT
Who should we call/write concerning this
Address: oLtu �vs�l � — City � vnJlq►� ---- state _LL Zip
Office Phone: (— l>) �!� _-- Fax # E-mailE-nutil A/
`JS Cell # ----�- —C�L� -�A-_ C
APPLICANT INFORMATION _
Check any that apply: Change of ownership Change of use _ Change of name <New business
Business Nattte/Type:
Previous Business on this
Describe the proposed business including use, number of employees, number o1f s�i�ft-s, ava'lable parking spac .•, number of
vehicles, and any m
additional information that you can provide:y�nt�5
"This Clearance will only he valid on die 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 l own or have the owners permission to use the space indicated on this application. I also certify that the intirrination provided
is true and a� date to the t of my knowledge. I have read the conditions of approval, and I understand t emm
, and that 1 will abide by the.
Signature j\
— Printed K >,4_
APPROVAL INFORMATION
KApproved as proposed I I Approved with conditions Denied
j Backllow prevention device and/or current test data needed for this site. Contact ACSA. 977-4511. x 117,
No
physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
site plan.
I I This site complies with the site plan as of this date.
Notes
Building Official — _ ---_ Date _---`���L ----
Zoning Official Da tc
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 246-5832 Fax: (434) 972-4126
Revised 1 I/02/2015 Page 2 of 3
Intake to complete the following:
yt. ►n 1.1, HI or PDIP zoning'?
Engineer's Report (CER) packet.
If so. give applicant a Certified
Y
Wil there be food preparation?
If so. give applicant a Health Department form.
7oning review can not begin until we receive approval from Health
Dept. FAX DATE —„_---_
Circle the one that applies
Is parcel on private well o Wi water?
If private N%ell. provide Health Department form.
Toning re% iew can not begin until we receive approval from Health
Dept. FAX DATE _-----_
Circle the one That ap '
Is parcel on septic t • PU-W sewer'?
V/ N
Will you be putting up anew sign of any kind'? If so. obtain proper
Sign permit.
Permit #
VN
l there be any new construction or renovations?
If so, obtain t roper rPerrmit. r t
Permit # '�
Zoning to complete the followini:
Reviewer to complete the following:
Square footage of Use: �2 q I L
J N
'nitted as:
� -
Under Section: 2-4.2,
Supplementary regulations section: N 1O
Parking li>rrnula: LO 0 50 P � f7-4'-7
Required spaces: S .� ( 1(30 W I —
Y/N — Cl
ften . he verified in the field.
La
Inspector: _ Date:
Notes:
---� -ST17
-
Viol aS:
Y
If st. ►st:
NOne
Pro
Y / N
If st1..J�ist:
------- —
Vari e:
1
Y/ t:
If so, rs
�
�-
SP's: -----— --
Y/�
Y
If so, tst: / /0,� e
-- -
Clearances:
f2-0 (8 °`---
SDP's --------^— ---
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4:7-
Revised 11/1/_'015 Page 3 of 3
SAN LATERA
POSSIEL
CONNEC-IEN
I
SAN. LATERAL
RICHMOND ROAD
STATE ROUTE 250
(VAR/ABLE R-0 W)
Scale I
99 709
w .balzer.cc
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^ew -.1 Vanay
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smuamn
Nanisoneura
Balzer and Associates,
1208 Corporate Cirde
Roanoke. VA 24018
540-772-3580
FAX 540-772-8050
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DRAWN EY PBR
DESIGNED BY
CHECKED 8Y _
DATE 2019-12-13
SCALE 1" = 30'
REVISIONS:
SHEET NO.
1 of 1
J03 NO. S0700006