HomeMy WebLinkAboutCLE201800002 Application 2018-02-05Application for Zoni
CLE # 15gearance
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OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS
Check # 7t Date: 1-a, l
Receipt # 2. Staff. '
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PARCEL INFORMATION {{
Tax Map and Parcel: ilibc.tw,rtc O y ;ro k! y "a f� a l Vq6 CO Existing Zoning CIO' A,( bv5lw5t u fe)^' I
Parcel Owner: ivy Fccutyi , Ll C
Parcel Address: XaGD Old IVY Rd Su.-k 100 City ct„4[pttesv,11G State V, Zip 2z4p3
(Include suite or floor)
PRIMARY CONTACT
�a.'c IL. 1�4K ifs
Who should we call/write concerning this project?
Address:'),2.00 o Ia ray Apt Sv, k !Gv City (J"'XtC'HGSV"1U State V� Zip ZzQt('3
Office Phone: (tl� 1-gS= 6 !6 7 Cell # Fill # E-mail P hart iserlt�j %w r �• c
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use >. Change of name New business
Business Name/Type: liar—Tr'w 1 L UC- hjano�cchtrr.�c1 F Seta t oL T Nx�i LLwf svrlxas <cu
Previous Business on this site Lee
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
'TK''s
vehicles, and an additiona(l infpop_rmation that you can provide: loch �-c . s�4 s o({e+ wr �f. /u 41^iyu roy ce.7 .
wwo wwjc > si+lft tru•`e $:awhM� - S;ewP�h, 14 c« c.r K%s 5 10 1v3
e(ac5S +ip .not{c 1 15. s, . hiC GCf� r rc irvK waKl 71 0 tCt je� aA
*This Clearance will only be valid on the parcel for which it is approved. if you change, intensify o move the use to a new location, anew Zoning '
Clearance will be required. 0.
3
1 hereby ccrlify that 1 own or have the owncfs permission to use the space indicated on this application. I also certify that the information provided
is true and accurate toAt best of my knowledge. I have read the conditions ofapproval, and I understand them, and that 1 will abide by them.
Signature Pas,1,~ F )}+✓' h'v, ct Printed f a '� k C I -a nsj G+,
APifROVAL INFORMATION
[ ] App ved as proposed ( J Approved with conditions [ ) Denied
[ ]§AfUow prevention device and/or current test data needed for this site. Contact ACSA, 977.4511, x 117.
[ ,,j o physical site itmWction 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:
L%�G
Building Official _ hate
Zoning Official nh Date
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 9724126
Revised 11/02/2015 Page 2 of 3
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Intake to complete the following:
P>.
Y
Is use to LI, HI or PDIP zoning? if so, give applicant a Certified
Engineer's Report (CER) packet.
�T
YIN
Wiltificre 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 --'- ti
Is parcel on private well of public water?
If private well, provide HealttrDepattment form.
Zoning review can not begin until we receive approval from Health
Dept, FAX DATE
Circle the one that applies
Is parcel on septa r pu Ile sewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit. L
Permlt# t�aUlGi i'e�`Ulle scr,'fe �F-fyhll
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit Of
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: 3 (a
aned as: t d�PSJI 0'h%� Q1Uv
Under Section:
Supplementary regulations section:
Parking formula: J ri L
Required spaces: P - f
YIN
i be verified in the field:
Inspector: Date:
Notes:
Violations:
YIN
If so, List:
Pr c
YJN
If ist:
Variance:
YIN
If so. List:
J'
SP's:
Y/N
If so, List:
Zc1lZ--1
Clearances:
SDP's
u�lt' ly
Lee-Tornts
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Revised 11/1/2015 Page 3 of 3
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CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
This form must accompany zoning applications (Nome 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 J \Ii Fv,(u'"^ 1 I - LC the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number 6)(0 a0 -Oa -00 —O yLCO by delivering a copy of the application in the
manner identified below:
Q 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 r
Mailing a copy of the application to �U' 7 "r�Z-L C
[Name or 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 It • 2 $ - 1 to the following address:
Date
31`{ C-st ►J"-ftr St �_�11Wl�ite5v� stet VA )agoa
[address; written notice trailed 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].
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Signature of Applicant
RJY--oc- e- 14a-A51e,-\
Print Applicant Name
Date
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