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HomeMy WebLinkAboutCLE202000005 Action Letter 2020-01-08APPROVE© by the Atbemarie County Applicati arance PLEASE REVIEW ALL 3 SHEETS OFFICE USE ONLY Check # Date: ZUZO Receipt # Staff:_ PARCEL INFORMATION ` , Q2 _ �`� _ 5 Tax Map and Parcel: V Existing Zoning (1 cQmmeccla l Parcel Owner: TbA \,�J Pa„rn �r hft a t Parcel Address: S3S �/ es+G-eg Q Slci tC Coy Ckg 1f-Io4--sy le -State VA Zip (include suite or floor) PRIMARY CONTACT Who �n S�ye-I should we call/write concerning this project? cke r Address(0G City CkGZ1r'j6++1�&'A 1State VA'- Zipo-Q�0�, Office Phone!' 8:- ) 4 a I ell �4)59 -jq ?) Fax # E-mail-_ _ SA r & D @Cville Mind Wrks.Ca APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name business �nNew Business Name/Type: Sly -el c� k � LLC / t l f w0 Previous Business on this site�� q I f S N ki ai-n L P(-ctc-H GP 3 1 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: rC C3 f "S_� Q iri=0l *This Clearanc 11 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 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 2 _ Printed ��Pyr f� LLki 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, xl 17. [;�Q 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 Zoning Official Date 0 I Z02-0 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/l/2015 Page 2 of 3 Intake to complete the following: Y AO Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y / Will t ere 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 public water9 If private well, provide Heat 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 o ublic sewer? Y / Will u be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Y �r Will 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: 2 5 3 Y rmitted as: Of Ai CC S Under Section: ZZ' ` Supplementary regulations section: .11/C, Parking formula: i f .Z 1V S f Required spaces: 2 Y / ) Items to be verified in the field: i4dzIt,,rc(-e- Inspector : Notes: Date: Viol? "'ns: Ifs st: (iv Proffers: If so, List: n vie Vari ce: Y / If so, List: �o SP's Y If so0, ist: Clearances: �le wil tot SDP's Cjq ► I 1 S j We/ -Fif ld P]W rf'1 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, Zp Lle( va n (v. q ,� / [County application name and num r was provided to F/ V I � v Po Yhie the owner of record of Tax Map [name(s) of the record owners o the parcel] and Parcel Number manner identified below: by delivering a copy of the application in the _Hand delivering a copy of the application to Nyi d m I ka r Mb [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]. Signature of Applicant Print Ap licant Name Date E-A+t-Ance-