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HomeMy WebLinkAboutCLE201900271 Application 2021-09-1421-Nov-2019 20:36 Fax 17572960042 p.3 APPROVED by the Albemarle County Cormnunih Development Department Application for Zoning nce �-- -- X - 11"� CLE # o� OFFICE USE ONLY 2 { ci PLEASE REVIEW ALL 3 SHEETS Check# �D 3 Date: Receipt # Staff: JAA 6- PARCEL INFORMATION Tax Map and Parcel: 056F1-00-00-00200 Existing Zoning - R C Parcel Owner:Shoppes of Clover Lawn East, LLC Parcel Address: 325 Four Leaf Lane Suite 8 City Charlottesville State VA Zip 22903 (include suite or floor) PRIMARY CONTACT Who should we call/write concerning this project? Juan E. Ocagueda-Corona Address : 408 E. Main St City Waynesboro State VA Zip 22980 erugma]a iscomxgn n6na.in Office Phone: (540) 941-5980 Cell # 540-471-5231 Fax # 540-9415981 F-mail gmail.com APPLICANT INFORMATION Check any that apply: _Change of ownership _ Change of use Change of name X New business Business Name/Typet Jalsca MBxican Grillarld CatttiLna, Inc I Full Service Restaurant - Mexcian Food Previous Business on this site Otto s Burgers 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: Full Service Restaurant -Mexican Food / 4 employees avq / 2 Shifts / Shared parking with Shopping Center / No vehicles used "This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or Trove the use to a new location, a new Zoning Clearance will be required. I hereby certify that I own or have the owners permission to use the space indicated on this application. I also certify that the information provided is hue and accurate to the best of my knowledge. I have read the conditions of approval, and 1 understand them, and that I will abide by them Signature —D—" n F Uf c-3—e elw '( Printed Juan E. Oc:egueda-Corona APPROVAL INFORMATION ( ] Approved as proposed [ ] Approved with conditions [ ] Denied ( ] Backilow prevention device and/or current test data needed for this site. Contact ACSA, 9774511, x117. [ ] No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing site plan. t ] This site complies with the site plan as of this date. Notes: Building Offs i Date Zoning Official Date 2-1 IV Other Official c Date County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 9724126 Revised 11/0212015 Page 2 of 21-Mou-2019 20:37 Fax 17572960042 p.4 Intake to complete the following: Is / Is u LI, HI or PDIP caning? Engineer's Report (CER) packet. If so, give applicant a Certified Y) / N 'Will there be food preparation? If so, give applicant a Health Department fort. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that applies Is parcel on private well or ublic wa If private well, provide Heal apartment form Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that ap tes Is parcel on septic or ublic sewer! Y/N Will you be putting up a new sign of any kind? If so, obtain proper Sign permit Permit # ZY/N ill there be any new construction or renovations? If so, obtain roper Permit Permit # � ?:1- 0 7-v $ g Zoning to comDlete the following: Reviewer to complete the following: Square footage of Use: Zl 2 G 7 _ ex S�dC0�f Y N Q 4't Mc ,r// ✓vtlJj f. e tted as: Under Section: Z56 , Z d G Supplementary regulations section: Parking formula: 5 I YA 00-) )L p �Y Requited spaces: 5pqto 90 V r. E1as4 N fe✓ 5OP7ef s to be verified in the field: -15 .t ric x; ,sty 3,cNq9e Inspector Date: Notes: / ZG 27)1( -© 9 Ok 2 t l C Vio19"s: Y /(N/ If so, ist: ZyI (? Proffers: Y/N If so, List: Zi'l�l d £1 (�Z 2L29� �r vari��, If //N._) Ifs t: -�- SP's: �l If / If so, tsi: Clearances: Zol9- zBK, -zIZ� -25 SDP's 201(�6, �ovS'-17L, zc<�a _7yL 2-0P&- +3�t� `ID/ a I1-z53� zot5'-2 itd fo 5 - Revised 11/I/2015 Page 3 of 3 21-Nou-2019 20:3B Fax 17572960042 p.5 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, Albemarle 6' LE -0 i - 0- l [County application name and number] was provided to Shoppes of Clover Lawn East, LLC the owner of record of Tax Map (name(s) of the record owners of the parcel) and Parcel Number 056F1-00-00-00200 manner identified below: delivering a copy of the application in the QHand delivering a copy of the application to Benton Downer, Co -Manager [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 11/21/2019 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]. Signature of Applicant Juan E. Oceg_ueda-Corona Print Applicant Name Date