Loading...
HomeMy WebLinkAboutCLE201900262 Action Letter 2020-01-31APPROVED by the Albemarle County Community Development Department `G6 B04 0-7Af",-)Qa 3 q N so()3 Applicatio 7bi ion Cal- nce CLE # FIP�ARCEL OFFICE USE ONLY ASE REVIEW ALL 3 SHEETS II �-7 Check# CC d-CL5�^ Date: lf Receipt # (I '7� Staff: NFORMATIO rnParcel: �5� O ,6( ''� �Q Existing Zoning l� Parcel Owner: Parcel Address: Rio on City State �' Zip q� (include suite or floor) PRIMARY CONTACT Who should we call/write concerning` this project? Kar4Q Vjy rr l �� Address: (Q (YD R�b irn-C) (A_, City _6ACAdU1rVikke State V c— Zip 010-col Office Phone: O Cell #ax # E-mail `Y-�-} burr;(► �qmq APPLICANT INFORMAVbN Check any that apply: hange of ownership Change of use Change of name New business Business Name/Type: "Y-G Previous Business on this site -N� Describe the proposed business including use, number of employee number of shifts, available parking spaces, number of vehicles, and any additional inf r ion that you can provide: *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 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 g 13 Printed �41.GZr IAA 9, b 1ounn` l APP VAL INFORMATION [ pproved as proposed [ ] Approved with conditions [ ] Denied [ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-451 1, x117. [ ] 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 %�G Date 12 %- // 5; 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 ccin Revised 1 ]/1/2015 Page 2 of Intake to complete the following: Reviewer to complete the following: 1' N Square footaE Is u n LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y / N ermitted as: Y N Wil ere be food preparation? Under Sectior If so, give applicant a Health Department form. Zoning review can not begin until we receive approval from Health Supplementary regulations section: Dept. FAX DATE J Circle the one that applies Parking formula: y i1b Is parcel on private well or If private well, provide Health ment form. Zoning review can not begin until we receive approval from Health Required spaces: Dept. FAX DATE rq,-) Y N Circle the one that ap ' s Ite t be verified in the field: Is parcel on septic public sewer? Y / N Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. , Permit # r Y / Wil ere be any new construction or renovations? If so, obtain the proper Permit. Permit # Zoning to complete the following: l 9 Violations: Y /M If so, rst: Proffers: Y //f�J If soL11st: Vari nce: Y/�1> If so, ist: SP, yP Ifs ist: Clearances: - SDP's A Pot ► Jam= 3 Revised I I/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,�O [County application riAne and number] was provided to [name(s) of the record owners of the parcel] and Parcel Number manner identified below: the owner of record of Tax Map by delivering a copy of the application in the Hand delivering a copy of the application to , t G � da n d e-w e$ [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 8 Yr 4a -�> zunn l Print Applicant Name �'1-1(Ig Date 6 12 COMMONWEALTH OF VIRGINIA DEVAR1 ENTOF SOCIAL SF.RVICFS CONTACT WITH LOCAL ZONING ADMINISTRATOR THE FOLLOWING INDIVIDUAL PLANS TO SUBMIT AN APPLICATION FOR A LICENSE TO OPERATE A FAMILY DAY HOME PURSUANT -1.0 § 63.2-100 OF THE CODE OF VIRGINIA To Be Completed by Operator of Family Day Home NAME OF APPLICANT Y)at-4-Q bur( i 11 PHYSICALADDRESS UCU �Z. () �-d \jC, 9,a-Ci0�` STREET OR ROUTE NO. CITY STATE ZIP 5�ic' APPLICANT'S TELEPHONE NUMBER: a E-0 MAIL ADDRESS: ,C_;,Cr— THE HOME IS LOCATED IN THE COUNTY OR CITY OF be --mc -` APPLICANT IS REQUESTING A LICENSE TO CARE. FOR THE FOLLOWING NUMBER OF CHILDREN (NOT INCLUDING CHILDREN WIIO RESIDE IN TIIE HOME): !a To Be Completed by Local 7Aming Administrator THE ZONING ADMINISTR'1TOR'S SIGNATURE ON THIS FORM VERIFIES THAT THE APPLICANT HAS INFORMED THE ZONING ADMINISTRATOR OF HIS/HER PLANS TO APPLY FOR A LICENSE TO OPERATE A FAMILY DAY HOME AT THE ADDRESS ABOVE. Tax Map N / I Parcel ll Vl Ir _ O Zoning District "j �W►�f'ra. c I � �i( � &E(Cc,- C sd.CJ8 Printed of Zoning in' rator Sign ire of Zoning., dmi 'strator C� 2 Date Telephone Nwnber: q 5q - a�� -� p 3 A X J a 9, Email Address: (T a s a.IP ()) a hefila-r/ 6 I 6 r CA Continents: kgMts k b) E l For questions, please contact your Area Licensing O ice (Inf4mation Attached) 032-0S 0982-03-eng (07115) ra 032-08-0093-00-eng (09/17) Virginia Department of Social Services REQUEST FOR COMFIRMATION OF COMPLIANCE WITH UNIFORM STATEWIDE BUILDING CODE SECTION I (to be completed by applicant) (Applicant's Name) (Applicant's telephone number or contact information) (Applicant's Address) �D �i©/-oWDT (Address of Facility) Type of Facility Assisted living (ambulatory) Assisted living (nonambulatory) VIld day care Adult day care (ambulatory)) Adult day care (nonambulatory) er (specify)f�J%Lj'�%A9�/��jt,� Y t`(�• Number of persons being cared for: SECTION II (to be completed by local building department or other authority responsible for USBC enforcement) Based on a review of our records and/or evaluation, the proposed use complies with the USBC. Based on a review of our records and/or evaluation, the proposed use represents a change in the application of the USBC which needs to be addressed with the Building Department before a determination of compliance can be made. Use Group Classification (if known) A — Date: f o� �2OZC� Signature of official: Name of official (printed): w Telephone number or contact information for official: