HomeMy WebLinkAboutCLE201900251 Application 2021-08-10I\J F11 q II-7)LB3w(,7I(ozH
((_ �i-ig Application for Zoning Clearan
'I F- 2ct9- 251 CLE r- t
PLEASE REVIEW ALL 3 SHEETS OFFIC
Check# USLY /
Date:
Receipt # Staff: 11/1
PARCEL INFORMATION
Tax Map and Parcel: 07800-00-00-015C2
Existing Zoning Highway Commercial
Parcel Owner: BALLIF INVESTMENTS LLC
Parcel Address: 170 S Pantops Drive City Charlottesville State VA
(include suite or floor) Zip 22902
PRIMARY CONTACT
Who should we call/write concerning this project?,_�,,.{��_
Address • [ -I a �y
� fit City�r•19e
Office Phone: V]t
•�) Cell # %�-g_ �gy_Fax#
Check any that apply: _ Change of ownership _ Change of use
Business Name/Type: JL. tl,. . L U/.._ /) <z-L a
Previous Business on this
Describe the proposed business including use, number of emp)
vehicles, and any additional) information that you can provide:
-t ms clearance will only be valid on the parcel for which
Clearance will be required.
State VA Zip 2t961
E-mail��ai{i pc,t-fir pL
of name ✓New business
of
you change, intensify or move the use to a new location, a new
of
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 be n knowled the conditions of approval, and I understand them, and that I will abide by them.
/' Signat t Printed y: �t1 � n „ i 1L
APC',ROVAL INFORMATION
[ Approved as proposed [ ] Approved with conditions
[ 17.
] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-45111 x j Denied
[ ] 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: (5'12f l6 /I Z Zoo `ZI
Building Official Date
Zoning Official —XZDate_ �Q` 31-
Other Official
Date
County of Albemarle Department of Community De
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5f
�j2otg-azY71-5
lent
(434) 972-4126
'evised 11/02/2015 Page 2 of
Intake to complete the following:
Y/N
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineers Report (CER) packet.
Y
Wi] 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 pubDwateIf private well, provide Hea form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that app
Is parcel on septic or ublic sewe ?
TY N
All you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Per mit# BZDC7jLr/-x—S
Y®
re be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: 3RSa (7
Permitted as: 1—G(uLo! ,L j �4e�q - Gt Sz-k"
Under Section: 2-k Z, ( t O
Supplementary regulations section:
Parking formula:
eN sp)9zaeb-1(L)
C/� /
zoo VtE4 (� lipwint� �e �a�
Required spaces:
I ceS
Y/N t
Items to be verified in the field:
5 zaob—I(Z
Inspector : Date:
Notes:
Violations:
Y/ M)
Ifsaist: ZV(0_Z-01S`L2C:ry,�List:
Proffers:
Y
If
Var�e:
Y I/t%
If s , List
SP's:
Y
Ift:
Clearances: Zoo 6-
SDP's
2�ov—tv�
Revised 11/1/2015 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, o ",I�V�� aj,l
[County pplication name an number]
was provided toCta..1� �pll i the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number o 18yo - t,o - oz- OI < C 2 by delivering a copy of the application in the
manner identified below:
Hand delivering a copy of the application to [Nam1'e of e oft
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
Q 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 to the following address:
Date
[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].
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