HomeMy WebLinkAboutCLE201800216 Approval - County 2020-10-15Application f r Zonin Cleara�ce�
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OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS
Check # D
Receipt # taff:
PARCEL INFORMATION
Tax Map and Parcel: 0 % 1 \IJ 0'01 Existing Zoning_NEtB-i-tP-oA , I ►Wei pls-r
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A
Parcel Owner: A rA v i Nt c e c pZ >
Parcel Address: 340 Gr6"TTSrtc4 4br City C 41 1't4!, State 1) A Zip zzgo l
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? L ( f,4D5A`C l LtS
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Address: 3LID G� 3�tc-yLp,�, City lJltl4t_ StateUfir Zip z29,�]
y39
Office Phone: (_ ) Cell # 32T-c 40lo Fax # E-mail R 1 [Do t� nl-tScc @�,mq;1 .
APPLICANT INFORMATION
Check any that apply: Change of ownership _ Change of use _Change of name New business
BusinessName/Type:-HA'2JC-5-r PA'P-tX
II '
Previous Business on this site__AL 1 f S 14j& U4t-:5ct
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: a Q t y TIA4 n yp, s 6,p
50 e tc, aHz
(n e. 6o1Ku+«,,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.
1 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 accura/tg� \the b/t of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed LI N D5 1f Ett rs
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:
Building Official Date
Zoning Official Date IU��aTI
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
Intake to complete the following:
Y N
Is use to LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y/QWill re 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 water??
If private well, provide He`altltD�parHni;nt form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that ap lies
Is parcel on septic public sewer?
Y
Wi ou be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y r N)
Wi ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the followinin
Reviewer to complete the following:
Square footage of Use:
Y / N dl
Permitted as: {�
Under Section: P.tCM)$n OIICKNI' 01 J
Supplementary regulations section. Z to A a011
5.1.2.
Parking formula:
Required spaces: 3o
It I�
Item o be verified in the field
Inspector : Date:
Notes:
Violations:
Y/N
If so, List:
Proffers:
Y/N
If so, List:
ZMA WII-o5)
Var!�ace:
Y/(N/
If so,list:
SP's:
Y/N
If so, List:
�cx�3— 8Fi
Clearances:
aol H - A
SDP's
�ooti -yl
2 7 —� (0 9 1
aoi -ti i
are 1-s6a ,a
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Revised 111112015 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,
was provided to
[name(s)
and Parcel Number _
manner identified below:
[County application name and number]
record owners of the parcel]
QHand delivering a copy of the application to
the owner of record of Tax Map
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]
m
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].
��
Signature of Applicant
C.,'v,®PS 5'/ /.'C
Print Applicant Nam r /
/o/jY
Date '
61W-01-OR-4
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61W-03-""6A1
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X61W-01-OA-9
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Legend
(Nora: some items on map may mt eayear in Ige�k)
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0.tober 9. 2018