HomeMy WebLinkAboutCLE202000016 Application 2020-02-20APPROVED
bar the Albernarle Cvunp�
COmmunity Development Department
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Zoning Clearance_
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OFFICE USE ONLY
Check # Date: `
PLEASE REVIEW ALL 3 SHEETS
Receipt # Staff: I\Ac--
PARCEL INFORMATIO
��C� Existing Zoning j ICE
Tax Map and Parcel:
Parcel Owner: - 0 ► NyC- ' jil F-nT-S 1LG
Parcel Address: CLy11 t�l lTri Sk i` City State Zip2z, i [
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project?�%1
Address: r 7 r,lyhlGy I'LL City ��Z1171'i 14 State ��� Zip
Office Phone: (' ) q71' 3i(, Z Cell #°'ffY-If41-3`tiv:2 Fax # E-mail llbi'%III t14K05(2 CJ,ilctt� ct o,
'"�br�i [laL�os� �}YVlCsc-t�„ CbV�.
APPLICANT INFORMATION
Check any that apply: of ownership Change of use Cha/n�ge of name New business
1Change
Y
BusinessName/Type: l-t2[ l-K.-6+ItS�, v7�r✓ 6 Lt eel Ol 1 I %S A ) -
Previous Business on this site OBI L:—
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 5 iC ` � 4, S ��'� Sc .t cl; fyr; I n i r`
to e'r�171u�� CS y ? a 1i(5 i4b" pAQI1%n�l 5ia s
*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 owledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed
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, 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 144IYDate Ar I,,q
Zoning Official Date 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 11/1/2015 Page 2 of 3
Intake to complete the following:
Is /
Is us in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
Will 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
If private well, provide He epartment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that appli
Is parcel on septic OK
sewer?
X)/ 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#
,551.t I C-3-2O
Loning to complete the following:
Reviewer to complete the following:
Square footage of Use: 2 9 9& P—
Permitted as:ytbyO -
Under Section:
Supplementary regulations section: �---
Parking formula:
b'? plev- 5Pf gffl� -Z1(
Required spaces: 67 6 q Sf��CyLeS
O(A Jt rl e-
Y/N
Items to be verified in the field:
Inspector•
Notes:
Viol?inns:
Y /
If so, List:
baQ
Prof
Ifs ,eiSt:
Varia ce:
Y/
If soOL , Est:
SP's:
If/
If so, ist:
Clearances:
SDP's
2Bc15-. It7
ZVf2-62 2o(7-T3
2,to-sg
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.
I certify that notice of the application, L 2 0Z O —1 (,
[County application name and number]
was provided to 's �ir \ ` w��S"l t t� the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number
manner identified below:
Hand 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 ("' ( V\yr-s YIn ,,X)
[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].
— .. 77�
Signature of Applicant
Print Applicant Name
1/:_:�1/2626
Date
Pantops Floor Plan Sk-1 a
118"=1'-0" - 11.20.19 1.21.20 rev.