HomeMy WebLinkAboutCLE201900280 Approval - County 2022-06-22APPROVED
by the Albemarle County
Community Development Department
Date /2 -(e -i i
7 S 1k3osrog PmSza ,l�-7
Application for Zoning Clearance
CLE #
PLEASE REVIEW ALL 3 SHEETS CFIC
h ck H USE ONLY (/Z;�I (�
Date:
Receipt N Staff:
PARCEL INFORMATION
Tax Map and Parcel: & I zo--o-3j-- (O Ao `)71 ,
��jj--�� Existing Zoning f' Vl.
Parcel Owner: ✓lt'yzE! / vYiC(}`IC.-tr
Parcel Address:I esl floc �,1 City � 1Btate
���1tt(mclu--lode suite or floor) _U T, Zipc-km
PRIMARY CONTACT
Who should we call/write cconcerning this project? cle,
Address :_ �n5 Q / F City _ State ��_ Zip q 7d'tt
Office Phone: (!&3 071 - 3c�?n # I Fax q
E-mail �%dinDt�T �4=. G�LCJ
APPLICANT INFORMATION
Check any that apply:.. Change of ownership !!i5
Change of use
'',.,�\ g Change of name _New business
Business Name/Type:,1hO(d� E1r F i(t! �3t(G1�n07sd F U�4 at -.Previous Business on this site Z n sn! S rr tr e jDescribe the proposed business including use, numployees, umber of srtfts, vaila le pa king spaces, number ofvehiclesd any additional in ormation hat you cde: Fn �q_k tti a1/1i165 f $Vl�I,�I,I (or , arty"This Clearance will onlbe valid on the parcel for which itd. if you change, intensify or move the use to a new location, a new ZoningClearance will be required.I hereby certify that I own or have the owner's permission toace indicated on this application. 1 also certify that the information providedis true and accurate to the best of my knowledge. 1 /ve readconditions of approval, and 1 understand them, and that t will abide by th m.
Signature '�`�`�-F Printed
APPROVAL INFORMATION
[ ] Approved as proposed [ ] Approved with conditions
[ ] Backilow prevention device and current test data needed for this site. Contact ACSA, 977-4511,, xl Denied
[ ] No physic17.
al 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.
Building Official Date fZ//jam
Zoning Official Date `Z— I O
Other Official ��{ �l 3i /J� ��
--r Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
ri2D(5t-r2,7ll 0271L -
.S Revised I1/02/2015 Page 2 of
i 017
to complete the following:
Y
Is n LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y�f N
Ill 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 :2 ,9{�lp/i =Vqk69-5
Circle the one that applies --
Is parcel on private well o lic wate
If private well, provide men! form.
Zoning review can not begin unt( we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Iss parcel on septic or pu c sew
Y)/ N
-Will you be putting up a new sin of any kind? If so, obtain proper
Signpermit j'/jZpl�_QL le-5
Peroddtt # (I iJ 27/2
Y
Wil there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Y
If so, List:
ZU
Variance:
Y/N
If so, List:
Clearances:
�b�3-36 L, .i i-a(Ij
��kfobti
( r
Y
Reviewer to complete the following:
Square footage of Use:
N
ermined as: _ I0- Z-1erk e
Under Section: 2-0r t{,
Supplementary regulations section: 5(1,06
Parking formula: l `B �dG✓tic, $ (1,6 'V— t
Required spaces: 7�-7
Y/N
Items to be verified in the field: /
P+tx t 5 V 4"fi c Gl'ULh4
Inspector
Notes:
List:
Date:
Revised 11/1/2015 Page 3 of 3
CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
This farm 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' t f e / `N 4t l el-1 the owner of record of Tax Map
[name(s) of the record owners of-4k parcel]
and Parcel Number by delivering a copy of the application in the
manner identified below:
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 Ro / IV l oA
[Name of he 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) 11 `
on I ) () — / to the following address: 63 7
-7 rr , Ala f 1p d � 50 1"e 100
Date SCD I S U U 18 A
[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].
Date