HomeMy WebLinkAboutCLE201900220 Approval - County 2022-04-20Application for Zoning Clearance wt=Lz0a
CLE # oZ�i -.q,�D
OFFICE USE ON V
PLEASE REVIEW ALL 3 SHEETS
Check # Date: l
lReceipt#_ Staff: i1A G
PARCEL INFORMATION
Tax Map and Parceld 3 LYl—C>0 - UO-O 2 t O D Existing Zoning ��
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Parcel Owner: /" AG - �2 � _
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Parcel Address: 10A.1City ,r�iyA, Statey[T ZipL��l a
(include suilk or floor)
PRIMARY CONTACT
Who should we call/write concerning this project?�(,[Ljl
Address: �� 0dox, SI8 % Cityr"(Cyzey ll State Vim• zip
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Office Phone: l W-fSPI Cell# Fax#ZQ3-8/69 E-mail Idoe4&Ile rTe-(A-
APPLICANT INFORMATION
Check any that apply:_ of ownership Change of use Change of name _New business
L /Change
Business Name/Type: Hor5e-- ZZk!L-t;,
Previous Business on this site
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:
*This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move the use to anew location, anew Zoning
Clearance will be required.
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 best of my knowledge. I have read the conditions of approval, and I understand and I will abide by them.
,,them, `that
Signature ,/ Printed (A% f �te Rere.l�
APP VAL INFORMATION
[ pproved 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 [he site plan as of this date.
Notes: %o [� 2oly— 13
Building Official Date 7l�Jr//2
Zoning Official Date / —gyp'
Other Official / ( i�-5CGP 0('C- (1q� -lygtl Date r7` Z-���
County of Albemarle Department of Community Development
4011 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
0 70q 2,'1 1/ 6-&Wt) Revised l l/l/2015 Page 2 of 3
Intake to complete the following:
Y/N
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
j N
Will there 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 t ' s
Is parcel or private we or public water?
If private we prove 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 o eptic r public sewer?
Reviewer to complete the following:
Square footage of Use:
Y N G I
rmitted as: 1�jxoj eut tj'
Under Section: S P Z 5— 3 r'J
Supplementary regulations section:
Parking formula:
2K� t1�(5 �cu/ tK5
Required spaces: Q air 9 tiR`t y
c
Y/N
Items to be verified in the field:
Y QN
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit # I Inspector
Notes:
WilMere be any new construction or renovations?
If so, obtain the proper Permit. 1
Permit # %jZDIQ 2Y(f �✓ �1ut5
Zoning to complete the following: /r 007015 — (3
Viola' ns:
[fle Cist:
Proff
Y VP
If so, List:
Variance:
Y/N
f so, List:
V /1 // —�i��
i� l ! i
S 's:
N
so, List:
Clearances:
--LL
SDP's
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,
[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].
S gnature of Applica
Print Applicant Name
Date
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