HomeMy WebLinkAboutCLE201900279 Approval - County 2022-06-22APPROVED
by theAH*malte County
Community Development Department
Date R-La-__7
Cv5>tiD�s£��VC 830; S31
Application for Zoning Clearance/
CLE # 2 G 6 — 2-7 G'l
___JOFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS Check # C L Date: 11 jZt-1
Receipt # —�— Staff:,
PARCEL TNFnRMA rffnW
Tax Map and Parcel: 79- i
Parcel Owner:
Fi 1t � \/H , LLC
Existing Zoning P T)
Parcel Address:, t'4e,(�jp�a �� City /j�_� O Ufl 1'u ^
(include suite or floor) \Jt�tate-�—� ziplaqu
Who should twee call/write concerning this project?
Address -G ]ONE ma City
Office Phone: 01 ,14Cell #
State(71
_- Zip
Fax # E-mail
Check any that apply: _ Change of ownership _ Change of use _Change of name _New business
Business Name/Type: Y,�,)lp/ ire / � )fir � ( of ie
Previous Business on this site,ll'S211a
Describe the proposed business including use, number of employees, qumber of shifts avatlabl parking spaces number of
ehicles, and any additional information that you can provide: I (.t /
s►LaFis �40 fi /�aa / ntZn �y t;,el //O
'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.
I hereby certify that I own or have the owner's permission to use the space indicated on this application. 1 also certify that the information provided
is true and accurl to the st of my owls ge. I have read the conditions of approval, and I unde tand them, and that 1 will abide y them.
Signature /
Printed 4Gaf l� pe
APP VAL INFORMATION �I
u4pproved as proposed ( ) Approved with conditions
[ ) Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, x 1 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.
Building Official
Date
Zoning Official Date
Other Official _( t/� fli �Q(/eL G(� Date
Countyof Albemarle Department of CommunityDevelopment
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
2DC�7`O27(3—S/ 027/k S
Revised 11/02/2015 Page 2 of 3
Intta�akke to complete the following:
Y�NJ
Is u inLI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
jYy 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 eC yp UeR~�e-5
Circle the one that applies
Is parcel on private well or pu ater?
If private well, provide Hqk6 De art rm.
Zoning review can not be ' ntil we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic or p c sew
Y)/ N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit. 02.0(1�- V Z -713 �5
Permit# tl BZ.7F`( S
Y/I)
W ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
romp to com lete the following:
Vions:
If , is
If t:
Variguee:
If
If i,)-Inisr
3 S
2flf)6-22 L a.t �5 c!z'la s to
to complete the
Square footage of Use: _ 5, Y 5 J
P nttted as: dG YCctyt-
Under Section: 25r 2.,
Supplementary regulations section:
Stl,ot5
Parking formula: k(1� ppt/b tiW'
to d �lCut
Required spaces:
27
Y/N --1
Items to be verified in the field:
�C7 ck tin e—CL4Gt -e
Inspector
Notes:
Proffers:
Y/N
If so, List•
SP's•
Y /�
If so, List:
SDP's
Date:
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 ��0 s) the rec e t N1r1 � C t( the owner of record of Tax Map
[name(s) of the record owners oft arcel)
and Parcel Number
manner identified b
QHand delivering a copy of the application to
by delivering a copy of the application in the
[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 _ -T01I AAS013
[Name bf 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 � I — 15 " /1 to the following address: Date 83 77 aA—Tof� d� sere 1X
5wtts� 6\e , A 2 leQ- SS'
L..... --, „uucc ,umjeu to me 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].
f/-18-1�
Date