HomeMy WebLinkAboutCLE202000068 Application 2020-04-14APPROVED
by ;he Albemarle County
Community Development Department
Date!' CY - Z-o
File LC-E 'Le
Application for Zoning 0earance s� Al '
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CLE
i (0FI 'E U.SF ONI Y'_. j
i PLEASE REVIEW ALL 3 SHEETS � Check it � �Z -o Date: -� 6
_ Receipt ? ! 7 staff:
I PARCEL INFORMATION
fax Map and Parcel: �M{��( �C.) Existing Zoning rn i is
Parcel Owner: L,
Parcel Address: 22C-1Pp -:EV Y y,) city'
�&p�i-mT`C5Vl1.L�tate VA Zip
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? (t
Address: jg q �t-5C it3 �y City A" i",+ State � � Zip.2�j 7) i
Office Phone: 6±)SILJZ51 Cell #t Fax # q• 345 �t G g-mail Bohr t�icb: � �eSt VS .C--
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name i New business
Business Name: i'ype
Previous Business on this site
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, nu ber of
vehicl�s, and any additional information that you can provide:
t "This Clearance will only be valid on the parcel for which it is approved. If you change, intensity or move the use to a new location, a new 7,oning j
Clearance will be required.
i
I
1 hereby certify that o n r ha o� er's permission to use the space indicated an this application. I also certify that the information provided
is true and acc:ur, h es f�fjS k vledge have read the conditions of approval, and i understand them, and that 1 will abide by them.
/i 11
Signature Printedc=T !'Sk
AP OVAL INFORMATION—.._�...._.
[ ] Approved as proposed [ ] Approved with conditions ( ) Denied
[ ] Sackflow prevention device andlor current test data needed for this site. Contact ACSA, 977-451 1, xi 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. Jr�Q ` 7
Notes: t'
Building Official Date l�
Toning Official Date ` ! �� 20
Other Official Date
-.ouniy ve tmuemane uepartment of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
G a Z0 ` Revised 1 I/0212015 Page 2 of
CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
This form mast rrccompanP iolliltg applications (Home Occupation, Zoning Cleormrce, Zoning
Administrator Determinations or Appeals, Sign Permits, Building Perinits) if the application is not the
owner.
I certify that notice of the application,
[County application name and number]
was provided to � [) � t � ��� the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number O 0- OCR g b � j� by delivering a copy of the application in the
manna identified below:
Hand delivering a copy of the application to
[Name of the record owner if the record owner is a
person; ifthe owner, of record is an entity, identify the recipient of the record and the recipient's
title or office for that entity]
on
Date
iViaiiing a copy of the application to �,� �, i d ___A� L L
[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 . to the following address:
Date
k(f . i 0kCzCkft�'-5Vj11iUcz �22$0�
[address; written notice mailed to he owner at Oe last known address of the owfier as shown on
the current real estate tax assessment books or current real estate tax assessment records satisfies
this requirement]. J
Sig ature of Applicant
Print Applicant Name
Date
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