HomeMy WebLinkAboutCLE202000032 Action Letter 2020-02-20APPROVED
by the Albemarle County
�cf` Community Development Department
r)a1'A
Applfb-fion--� �e Clearance Jft
S
CLE #
[:::PLEASE
REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check# 172-2- Date: l
Receipt # Staff:
PARCEL INFORMATION
Tax Map Parcel: ' G
and — �.� OCR Existing Zoning CI
Parcel Owner:
Parcel Address: ,,� 9ZI (A A 4 �� City (. State V Zip
(include suite or floor)
PRIMARY CONTACT Who
should we call/write concerning this project? 121�,�'�
CP.t'L'
Address : (9 �g ,, �C�i�efl� -City State V Zip 00 .
Office Phone: ( ) Cell # tf3lf— )6d 0 ax'# E-mail '
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: —(;A AN 6—
Previous Business on this site CZ(>( — EJ(5 L4+1
Describe the proposed business including use, number of employees, number of shifts, availablp parking spaces, nun.1ber of
veh'cles, and any additi I mformat'on that you can provide: (t
*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 an a the st o y m edge have read the conditions of approval, and I understand them, and that I will abide by them.
�teto
Signature Printed
APPROVAL I ORMATI
[.Approved as pro osed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-45 11, xl 17.
XNo 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 ,' / Ile- t f �
Zoning Official �f���� DateZ Z l? ?G
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
i�
Revised 11/1/2015 Page 2 of 3
f
Intake to complete the following:
Y
Is On LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y N
2ere 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 ubli ater?
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 appli
Is parcel on septic QO—U ' ewer?
X )/ N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
VN
ill there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to comnlete the followinu-
Reviewer to complete the following:
Square footage of Use: I
Y/N
ermitted as: O � -P C a° S i
Under Section: ZZ--Z . 1
Supplementary regulations section: (ti ) (Ot
Parking formula: /' n Q S Peer smf
/ fu V gvs ,c 3 5-
Required spaces: ( Z
Y /
Ite be verified in the field:
fj,l'C T IA q(�Cl�v'a �/Oy,'der
pu-,Y—� 11ne Clt'v�vv�l.. a.,0%✓rri ;A
Inspector:
Notes:
Date:
Viol,,*�ons:
Y /(NJ
If so, ist: t1O^ e
Proffers:
y
If so; List:
e
Variance:
Ifs st:
SP's-
If so, ist:
/V0_
Clearances:
c.�e zo l� 45
SDP' s
sc
e
Revised 11/l/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.
t certify that notice of the application,
was provided to
[County application name and number]
[name(s) of the record owners of the parcel]
the owner of record of Tax Map
and Parcel Number 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
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].
Sighatur�of Appli
Print Applicant am
Date