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HomeMy WebLinkAboutCLE201600284 Application 2016-12-30Application f r learanceCLE# M__9C a OFFICE U LY PLEASE REVIEW ALL 3 SHEETS Check # Date: -� Receipt # Staff 1 if - PARCEL INFORMATION p " 'I l) Q Tax Map and Parcel: �� ©f j - �j - (`� (� Existing Zoning r A Parcel Owner:-- V U J_C 3s c) 0la Tvci w y v7 l/a Parcel Address: Sy it Q, Q -City- G h Q rfaffds; State V61-c- Zip 2_4d 0 (include suite or flo r) PRIMARY CONTACT Who should we call/write concerning this project? TCPn4 Address : 3 0,0 Pre s+o A NQ/\.Jt- 'ci y 4 J]k"tate ✓A 22962- y Z Office Phone: (y3y) Z9 3- D Celi # 3y'32 7 Fa(x # 7 Lf�- 3 E mail • Ql� n� n C�G$2 i Fri 1)3 C" APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name V New business Business Name/Type: C IC St-- L'-V S On, Cr,-,y- ' C 1 A oy e, Previous Business on this site UKwQfj, .. v -- 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 rovide: 17n-/{J'f 0_-4Ak G�d Vl:kr/ 6•1b t S c s *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 certi tat 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 acc r e to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them. v 1 Signature Printed V � n � �V- V-'+nS APPROV INFORMATION ] Approved 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 the site plan as of this date. Notes: Building Official Date / Zoning Official L• Date _ / 2 g L2�} LZ 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 11/1/2015 Page 2 of 3 Intake to complete the following: Y/N Is use m LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y / Will are 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 or i;Wer? If private well, provide Hea nt form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that applie Is parcel on septic or ublic se r? YIN Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Y/N ill there be any new construction or renovations? If so, obtain the proper Permit. Permit # �Z c)/6-- -;1..S0-L 4 e,-1 Zoning to complete the following: Reviewer to complete the following: Square footage of Use: ;n,<Vi) (Y)/N Permitted as: fiC C� Le Under Section: Supplementary regulations section: Parking formula: �J Required spaces: Y / Items o be verified in the field: Inspector : Date: Notes: Viol ions: Y1 If so, List: Proffers: Y/ Ifs ist: Varian e: Y / If so, List: SP's: Y / If so, ist: Clearances: 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 a,4V L L C the owner of record of Tax Map [name(s) of the record owners of the parcel] and Parcel Number 06 000^ Gb- M- 0y790 by delivering a copy of the application in the manner identified below: Hand delivering a copy of the application to Coru \% r= Eoir0—, iha/1aQp/- [Name of the record owner if t e record Swner 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 12I/let/% Dat 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]. of Applicant Je.n Print Applicant Name 12�16//l� Date b SUITE 100 _ N a ro� g 350 OLD IVY WAY e= o N o : o m o CDm' tz Z > CHARLOTTESVILLE, VIRCINIA M m m