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Home My WebLink AboutCLE201900130 Application 2021-11-12APPROVED hu I1& Awum l irla County Cwmmi* * Develop Deparhmnt 45 5 0 4e °ie Z earanc =J21: 4 CLE # 1zqning9 �r '�»� OFFICE ONL -17 PLEASE REVIEW ALL 3 SHEETS Check# Date: ` s Receipt # Staff: PARCEL INFORM Tax Map and Parcel: jI _Existing Zoning G A— Parcel Owner: '5U'0)`-G)a'LLG tlp�Lb Parcel Address: �� U aeM5-_OCityc_ State (include suite or floor) 5v Jc_ fol A PRIMARY CONTACT Who should we call/write concerning this project? , / Address: 512.A 72-tAi df- C- City charlolitsydir- State A zip %Z91i rV 1 Office Phone: (� (C Cell # glg-1;o'7M Fax # E-mail r9ch j lderSEgrla, f.0 U APPLICANT INFORMATION Check any that apply: Change of ownership Change of use _Change of name business _New J Business Name/Type: 1114C Vi r(hIll i d. , LLC- Previous Business on this site rA+ej rcVi Ve H4-oM4, C¢.A4 r 01- C 6404f eSV i tie - 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: pu re�atiA4 lri a� �AeSS Ao Lbtgnw s iotl-}1 7- Ar%-+-in bc'' �Ma nft + c eM (* SS o(a sretf! 3 0ll dos . �cda bvstAc55 is o, n�+rt+ic,%O-k d1 tc 5ecrn' 17s"tAff -i 1.4i .J- for *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 owners 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. 1 have read the conditions of approval, and I understand them, and that I will abide by them. Signature Printed _ K'r C-ti t id ty"S 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, x117. [ ] 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 Other Official Date County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126 0.35 1 Revised I1/1/2015 Page 2 of Inta ke to complete the following: Is uIsLI, HI or PDIP inning? If so, give applicant a Certified Engineer's Report (CER) packet. Y //N J WiL441rere 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 Reviewer to complete the followin Square footage of Use: mK nitted as: 1`-i,PsY < Of t GQ Under Section: ZZk It t Supplementary regulations section: Circle the one that applies Parking formula: Is parcel on private well or lic water? F Z If private well, provide He artment form. I Zoning review can not begin until we receive approval from Health Required spaces: Dept. FAX DATE /p Y/N Circle the one that appl' Items to be verified in the field: Is parcel on septic o c sew Y/N Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # _ / Inspector Y / N I Notes: Will there be any new construction or renovations? If so, obtain the proper ermit. Permit # Zoning to complete the following: Viollons: Proffe s: lf If Ifs ist: If so t: Varijlt�e: SP's:J� Y/ jN is Y I jN J If so, Est: — If so, st Clearances: SDP's cLF-uwt5-10 C1yio�, o wl - - 3BCyZ 4, Zoly�(op 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, [County application name and number] was provided to the owner of record of Tax Map [name(s) of the record owners of the parcel] and Parcel Number _ manner identified below: 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 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]. 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