HomeMy WebLinkAboutCLE202000043 Action Letter 2020-02-27APPROVED
by the Albemwle County
Community Development Department
ApplicaW nin-C'karan ce
1
CLE #b�-o-j V� -
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY �J /
Check # Date:
Receipt# 2-O Staff:
PARCEL INFORMATION —fig
Tax Map Parcel: C�
and Existing Zoning
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Parcel Owner:
Parcel Address: City City State Zip
(include suite or floor)�'.,t ��
PRIMARY CONTACT
Who should we call/write concerning this project? -�_�� 2 Zr-2 Q3
Address: City—" 1. — fir,., 0 State V � Zip
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Office Phone: ( ) Cell # Fax # E-mail lcuu-✓`a p 1`O-c" . ai
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APPLICANT INFORMATION
Check any that apply: of ownership Change of use Change of name New business
J� IChange
Business Name/Type: �R l (
ihO (F
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Previous Business on this site
Describe the proposed business including use, number of employe s, number of shifts, available parking spaces, number of
vehicles, and any additional information 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 Printed
APPROVAL INFORMATION
,<Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-451 I, xl 17.
�o physical site inspection has been done for this clearance. Therefore, it is determination
not a of compliance with the existing
site plan.
[ ] This site complies with the site plan as of this date.
Notes:
Building Official
G Date
Zoning Official �Date Z Z 7 Z�
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:
Y&in
Is 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 publ' water?
If private well, provide He partment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that ap
Is parcel on septic oulumlk sewer?
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 followinue
Reviewer to complete the following:
Square footage of Use: 143
Pe2itted0 � f-, ce
as:
Under Section: -24
Supplementary regulations section:
N/�
Parking formula:
f 1 ZoD fv j- F
Required spaces:
Y N
Ite be verified in the field:
Inspector•
Notes:
Date:
ns:
VioKtn
1 �(Ni
If so, ist: N
�titie
Proffers:
Y / N
If so, List:
Vari ce:
Y /01
If so, List:
/�I o �
SP's•.
Y /
If so, ist:
Clearances: ((
SDP's
Revised 1I/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 Deterniinations or Appeals, Sign Permits, Buil(ling Permits) if the application is not the
owner.
I certify that notice of the application,
[County application name 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
[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
2�-�
Mailing a copy of the application to `vs Y (ZoSS I
[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]
Oil
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].
ure of Applicant
Print Applicant Name
ate
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