HomeMy WebLinkAboutCLE201800023 Application 2018-02-20Application for Zoning Clearance
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE. ON Y -4 6(
Check #' lk", Date: f J y /
Receipt # Staff: e
PARCEL INFORMATION
Tax Map and Parcel: D G 1 Z 0 Existing Zoning PPS(—
__44"'
Parcel Owner: Rio Acs.COCt4OF5 `,tYb! VQQ�'�7iP
Parcel Address i'044�-GSNANO �_ S�% City Vc Cq.fitate Zip
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project?
Address: 3 ��—�" �`'0��-City I,WSttiJ-tzUru�tate Zip
Office Phone: # Fax # E-mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: tA C_ Z P� (
Previous Business on this site C_itl'_> K ]
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 provide: d C►�-vp ,
*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 3rnission to use the space indicated on this application. I also certify that the information provided
is true and accurate to the bes I have read the conditions of approval, and I understand them, and tthat-I •will abide by them.
SignaturePrinted
A ROVAL INFORMATION
] Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] $ackflow 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 1 Date �e /
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 2 of 3
Intake to complete the following:
Y /CN)
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y N)
Wil 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 ublic wat
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 ap —�
Is parcel on septic public sewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign perm
Permit # I a 01 S
Y
Wi(Z)re be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: 0 C/JEQ
/ 1
ittedas: 01O PSSIof1c Iof(UJ1nw1 N1A
l
Under Section: 2 S, 2 . ( 11 \
Supplementary regulations section:
23.2 •t lrl
Parking formula: I' 2 Q o ne y
Required spaces: i
Y N
Ite be verified in the field:
Inspector:
Notes:
Date:
Violations:
Y/N
If so, List:
a�a�e�i
ffers:
Y/N
o, List:
Zr' 197 -Z�►3
A-Priance:
so List:
` 7 1 7-
N
So,List:
d _ Cl 10; 11 z 63 20-11
1.19q-11.101
—
Z
—Z
o `6 '5
1
1 r, G E, Q U ,
Q-7
Clearances:
zoor. - VK ckly A %(�
SDP's
c( --50
Revised 1 1/1/2015 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, 20IV 4-'C-, V_
(�
[County application name and number]
was provided to P%,t. n CSS oc-c� �� �� I ^`T�`�J NILT-.— the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number
manner identified below:
Hand 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 J t N^- U
[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 1 '1— z2fo l 7 to the following address: � J P-a'NAZ-o .a r?'t-i1 Cam(
Dafe
(0 CGS
[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].
Signature of Applicant
Print Applicant Name
1 /2-5/Z'::::) l Ev
Date