HomeMy WebLinkAboutCLE201600262 Application 2017-07-26Application f!0gZ
CLE # 101
0 in Clearance
OFFICE S LY
PLEASE REVIEW ALL 3 SHEETS Check # Date:
Receipt # Staff:
PARCEL INFORMAXON f
Tax Map and Parcel: >J T Existing Zoning_ P_`y
Parcel Owner:_ -) yy,� Ul.
Parcel Address:_)4p ACC City
(include su' a or floor)
to VOL ' Zip z1fro
PRIMARY CONTACT
Who should we call/write concerning this project?
Address : IS,Q.YHI r)pl �j/'Q) 1 City l(/ I' State �. _Zip ZZ
— L
Office Phone: Z —1 7 Z Cep ##S — Fax # E-mail
APPLICANT INFORMATION
Check any that apply: Chang of ownership C ge of use Change of name New business
Business Name/Type: f WA4A 1 , '�2 �
Previous Business on this site d 0 -P ,
Describe the proposed business including use, number of employe s, nu ber of Ifts, av i!)able p ing spaces, number
v icles, and any additional information that you can prov de: 0 r 5
�o
,s o a
*rhisiClearince will my be valid on t 1 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 o o have the o er's permission to use the space indicated on this application. I also certify that the information provided
is true and accurate to e b t of my wledge. I ave read the conditions of approval, and
derstand em, and that I will abide by them.
Sienatn?�-_ w / �/i/1/i.� D :_. a lwl... ►—�. _ �.
APPROVAL INFORMATION v
�:Pkl 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 \ ' Date
Zoning Official Date
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/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.
Y/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 that applies
Is parcel on private w or public ter?
If private well, provide ealth Depa ent form.
Zoning review can not beg a receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic or�satjf�er?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
.Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #�14
Zoning to complete the followin
Reviewer to complete the following:
Square footage of Use: f JD
N
Permitted as: AJQJJiy►��y4�ps n �A,
Under Section: 4tMIV)
Supplementary regulations section:
Parking formula:
Required spaces:
It /
Item be verified in the field:
Inspector : Date:
Notes:
Violations:
Y d�
If s , List:
Proffers:
Y /N
If s6ist:
Vari ce:
Y 13
If so, List:
SP's:
Y N
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, �O OT
[County appydation name and number]
was provided to the owner of record of Tax Map
[name(s) f the record owners of the parcel]
and Parcel Number &q- - I b 4 by delivering a copy of the application in the
manner identified below:
V Hand delivering a copy of the application to L)"te,
[Name of 1he record owner if the cord 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 f r t7ientity]
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]. 1---N
Date
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t SETBACK
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t CONSERVATION ` LEGEND
' EASEMENT .� L� STORM PIPE
`SCALE 1 "20' t` 120'11 SF r�
lI DROP INLET
0 1 20' 40' CURB & GUTTER
LAND COVER SUMMARY t ' t — — 200 — EXISTING CONTOUR
BUILDING, PORCH & PATIO: 2,200 SF ` 1
DRIVEWAY: 540 SF ` 200 PROPOSED CONTOUR
YARD: 2,479 SF � L + 1"_ TC 240.5 PROPOSED SPOT ELEVATION
�p HOUSE SITING EXHIBIT FOR &s S� EXISTIN G SANITARY SEWER
NL LOT 1 w PROPOSED WATER LINE
DI�NLORA V
�I Q$3 PROPOSED WATER METER
Q� 1'
RIO DISTRICT, ALBEMARLE COUNTY, VIRGINIA
DATE: SEPTEMBER 22, 2016 _ x GROUPw.. ,.
FiMMONS