HomeMy WebLinkAboutCLE201800215 Approval - County 2022-06-28Application for Zoniq C�earance
CLE # ['
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # (J47A Date: 10' [ 0 ' I C
Receipt # I] Staff: 1T
PARCEL INFORMATION I p _
Tax Map and Parcel: / 6' S S C- I o I Existing Zoning t z
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Parcel Owner: l ux-ok Lui_
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Parcel Address: I["1bS Raid., A. '\ldF (a[ City �-ha�r��es�-"��P State ��/� zip It
(include suite or floor)
PRIMARY CONTACT �+ �
Who
should we call/write concerning this project' . �p enon
Address: 194 ;yse6 l lbr6j� Cityaarl/ -_[lt]j��+w:/t - State V,�V Zip '72911
Office Phone: ) `(79- 9 18'1 Cell # `0Y-Tee,%? ,?e Fax # Y3Y A 44. 3Q0 E-mailcewr
APPLICANT INFORMATION
Check any that apply_ Change of ownership _ ChangeChange of name New business
,/ofu�se
BusinessName/Type: pc_U,`Lkze UCA6a 0.4ma.1 ,,A t"k�se:4ks I'4EDIC-tgt_ oFFtCl-
1VoR7-0.V Z.FISHAfAw, MA
Previous Business on this site S+rl .col Lw_� 17zeni(
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicles, and anyy additional information that you can provide: N1 L-plc-A ._ c5 �RrLE - � - 3 CAW icve e5
2-9y�lv let - 24 Pa 6 0 Sna . Pr 7,v lo, Rw ld
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*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. I also certify that the information provided
is true and accur a to thel best of my knowledge. I read the conditions of approval, and I understand them, and that I will abide by them.
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Signature �Nor� P_ , IVlan Printed S7Lz09 :W Al. /Y/bz7_0A1
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 AJ Date
Zoning Official144LLDate
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
Revised 11/02/2015 Page 2of3
Intake to complete the following:
Y/p
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y / (!Vi
Will t ere 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 that applies
Is parcel on private well o ublic water?
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic cr ublic sewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/
Will t ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the followine:
Reviewer to complete the following:
Square footage of Use: (1 O o{ % S 2 . E+
Y / N
Permitted as: �/
Under Section: 2/ A I
Supplementary regulations section:
Parking formula:
Required spaces: f
Y/ J
Item to be verified in the field:
Inspector : Date:
Notes:
Viol"* ns:
Y/
If so; ist:
Proffers:
Y/N
If so, List:
ZMA QgoH-
a
Varj
Y N-'
If so, List:
SP's:
Y
If so,pist
Clearances:
0L1.-_—�I1
SDP's
M9-i�3
Revised 11/1/2015 Page 3 of
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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, zewllo 6 L"4eW4q-A)CC
[County application name and number]
was provided to L t,/rce7r^ L(. C the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number 7 K - SS j} c - ( Cb I by delivering a copy of the application in the
manner identified below:
QHand delivering a copy of the application to _ L k >c o r L t, C--
[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
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
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].
cSignatur6 of Applicant
STL P14 L ni /1k . A L L j oN
Print Applicant Name
/j o-r�
Date