HomeMy WebLinkAboutCLE201900293 Application 2020-01-02APPROVED
by the Remade C
-v—.,•..wl.r�nc�ll U
pp ication or ZoningClemnce r
CLE # _. File
OFFICE USE ON Y C�
PLEASE REVIEW ALL 3 SHEETS Check # �4A Date: t
Receipt # Staff: L
PARCEL INFORMATION ftc
j
Tax Map and Parcel: % 7 L F Existing Zoning /
ParcelOwner: 6ko5S ltw
Parcel Address: City State Zip
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? V-L-0 N
Address : A 33G M Alf-Se4 404 t F-0 City C �M �2oCC'ya,u State 7� Zip
'Its zte, 13bS3
Office Phone: Cell # Fax # E-mail f a-3-" �25 C"`;'s nE_U'-k,,,'P wtcw
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: Cask 3l'— Ct LLt_s (csxl C(nj Z C-,,e,
Previous Business on this site V 1 PA - P_C,L L
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: A%$1G,rAe.6iLLr eA Lt- tWd-,J V_t4i A 1-f—
*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 tothebest of my knowled . I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature `y' � Printed /�-� r� X8 Cat L&S5
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, x117.
[ ] No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
site pl n.
[ I his site complies with the site plan as of this date.
Notes:00,
Building Official Date % `Z-2_0
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
020 - P 307 `]--0( Revised l l/1/2015 Page 2 of
,A;cr
Intake to complete the following:
Y/N
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
WIN
If so, give applicant a Certified
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
Is parcel on private well Ozpgiiwa .
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 applie
Is parcel on septic ublic se
Reviewer to complete the following:
Square footage of Use:��d��
N �yy f
ermitted as: `�o r(VCtL Jl� r S�� S
Under Section: Zq i 2 �, ( C Z
Supplementary regulations section:
Parking formula: *" p(, � Zl3rl�
Z3j —k q 2�z
Required spaces:
Y / N l S� (agt_a15.
Items to be verified in the field:
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit # Inspector
0i/ N Notes:
ll there be any new construction or renovations?
If so, obtain the proper Permit.
Permit# 526j�—o3o+)%`A(:
Zoning to complete the following:
Viol ons:
Y/
If so, ist: ,j I/ ��� t A' i ,
f` t t �jC
Proffe
Y/
If so, st:
Vari e:s:
Y/M
If so, ist: �.
N
�/,
o, List:
Z Cg((6v
Col (�S ►oil
Clearances:
SDP's
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, c L F 7 r ( [ - Z C -3
[County application name and number]
was provided to ( 9z;55 i 6`4 L"Lv,P r�1L'�� CC � t`1"�
p C lt,-�ec.�-rt cat, �tL`'t)�e owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number 7 7 1 F 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
V Mailing a copy of the application to C asg (�c J��Lc 7zC 5 t 1 &
[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 thaat, entity]
on i Z / to the following address:
Date
[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
c. �
�s
�t C t 3 j rt-E—►�--
Print Applicant
ame
\2-, jc, 19
Date