HomeMy WebLinkAboutCLE202000014 Action Letter 2020-02-12APPROVED
by ti'1e Albemarle County
ApplicatWfor to"iilifg'tiearance
eLE #
OFFICE US ONLY
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PLEASE REVIEW ALL 3 SHEETS
Check # / Date:
Receipt # 1_17oi, Staff:
PARCEL INFORMATION
Tax Map and Parcel: D E I Z 0-- 03 '-to ° I LO) I nD Existing Zoning
Parcel Owner:-Av1-I-I/v,,X V0! 1e-vl+e, E5q� P.O,E30X7.94 Chejrlo4fe�,yllle _;4-qgo6
I�PId l�1U�vgtcvi D✓lve'.
Parcel Address: S t4 i -� :� 5 ,A City C ! t a r o } 5 v i ate �A Zip �) (7
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? F I e, e In ►^ 1yl D
Address Dc4\,1,-_vi+ry L_ v1 City C h n vl I o+4 e, t,vi I ate VA Zip as C1 I
43 ,
CC
Office Phone: (� Cell # d -5 _ � � 55Fax # E-mail ►^ e v1 e e l Tl S C k e V
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name) t/ New business
Business Name/Type: C ('"t a v' 1 o++ e' Z v i lie, l h+e rr v► G1 ( M e d t G I Vl e 6L A i v i S i O w
o , vtGinvv H e-,-i 14k6eAv-P P LG
Previous Business on this site ►= ca v" i I P r' r, c: t- Vat { o v1 ; e I,- v' 1 C. e,.Q
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: h yS, 1 c 1 a v1 ' s e f f i G el 5 e v)J210X5,e6
ope" 9 ';) pryl 4ihGye, 4 P4"0k-lvlq L B► C1y1GH Ian PVof{ �.61CJyicll C Pv1+L ✓
*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 �— Printed PZ.e- o e e F I r. c-- k e v
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.
(<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:
1 l �-, L.7: C c�� e t.,f;
Building Official�/U._C'L� Date
}i/,
Zoning Official �f " ����- Date / f 2"
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 11/02/2015 Page 2 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 C.. L 2-62-0 —
[County application name and number]
was provided to
^vi-}-0ooy V jevi+G
[name(s) of the record owners of the parcel]
and Parcel Number
manner identified below:
Hand delivering a copy of the application to
the owner of record of Tax Map
by delivering a copy of the application in the
4h�v,%/ V14e,
[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 ► 1 1 + 1 9-0
Date
0 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]
ME
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].
Signa of Applicant
2 e n ee� F'i 6 c v) e r
Print Applicant Name
�+
Date
Intake to complete the following:
Y /O
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
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 o public water?
If private well, provide Hea Depart orm.
Zoning review can not begin un i we receive approval from Health
Dept. FAX DATE
Circle the one that ap s
Is parcel on septic o public sewer?
Y/N
Wil be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y /
Will Vere beany 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:
Uitted as:
Under Section: Z o . 4- . 1 -�
Supplementary regulations section: N J4—
Parking formula: i' - p O ry s F
Required spaces: I
Y/N
Item o be verified in the field:
Inspector:
Notes:
t o vu(-e 0•-) 5 a l 7
Date:
Viol��ons:
If { N)
Ifst:
N
Pro s:
Pn
Y N
If s st: �Q
Variance:
Y/
If so, t:
Ai p
SP's-
Y/
If so, st:
Clearances:
(" .i 2� 1 O,(l O /_O
SDP's
Revised 11/1/2015 Page 3 of 3
Initials: I