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HomeMy WebLinkAboutCLE202000013 Action Letter 2020-01-27APPROVED by the Albemarle County Appficpm onr19__learance � /MIDI\P PLEASE REVIEW ALL 3 SHEETS OFFICE USE ONLY I i��IZOZ� Check # 2 Date: 1 Receipt # O ` Staff: PARCEL INFORMATION /_ Tax Map and Parcel: cC� w�f�� UGC '"Z�(-DQ Existing Zoning Parcel Owner: L - L S k a l" M a '�I �1 D WR4F nn City i y L]harI , I A — Parcel Address: t >✓� a K-Oa L� 0 �fS t1 +tl e-State V Zip aqClnI (include suite or floor) PRIMARY CONTACT Who should we call/write concerning this project? Address :1gp V) 4fjeId(r(j Qu�, � City D�adt inn t- State 00t Zip 0ag0[ Office Phone: d 34) a q q - � 9 53Cell # Fax # E-mail 61 (1 -e (, fC�M � �, p APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business Business Name/Type: k R ,,p � Nxc f, L L L, Previous Business on this site Describe the proposed business including use, number of employees, number of shifts, ava'lable parkipg spaces, number of . vehicles, and any additional information that you can provide: C i *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 wn or have t owner's permission to use the space indicated on this application. I also certify that the information provided is true and accurate t the best of y knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them. Signature - -` Printed Q tot ex �� l'/ Gt ra Aed APPROVAL INFORMATION j.-q:'Approved as proposed [ ] Approved with conditions [ ] Denied [ j Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, x117. J>�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 (Z ZD Other Official Date %.vunty or Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126 m Revised 11/02/2015 Page 2 of 3 Intake to complete the following: Y Is a LI, HI or PDIP zoning? Engineer's Report (CER) packet. If so, give applicant a Certified YEN Wil 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 ub ' ater? If private well, provide Hea epartment form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that appl' Is parcel on septic o public ewer? 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: Y) it / r( C��" rmitted as: T�— Under Section: Z 2 ` Z ` Supplementary regulations section: N / Parking formula: Required spaces: Y N Ite be verified in the field: Inspector : Date: Notes: Viol ons: Y /) If O"LAst: ProfWTIN Y /IN If sx, t: Var' e: Y / N Ifs Li : SP, Y If so, ist: Clearances: j le SDP's -)00 ZOO C� 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. I certify that notice of the application, C (- E Z ©Z 0 13 [County application name and number] was provided to ( r- 2 � Gy 1112 L t C the owner of record of Tax Map [name(s) of the record owners of the parcel] and Parcel Number 6 �✓ i ` f� C p� l �� manner identified below: QHand delivering a copy of the application to by delivering a copy of the application in the [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 o Applicant Aloes A154awyakl' Print Applicant Name /rl� 2 Date r W W f11 0 -1