HomeMy WebLinkAboutCLE201800060 Application 2018-03-13Application for ZoninLy Clearance`°`�
CLE# Off 00t)Uo
PLEASE REVIEW ALL 3 SHEETS
OFFICE SE ONLY
Check # Date:
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: 0600p-oo-- c)o - o25cw Existing Zoning CDm-e-wiej
Parcel Owner: RIB Riche \10'A Gor F:�"14cog In`.
Parcel Address: 2-'fz4 Iv p-t(. 3:,i+e I2,- City Ur d.4ksAe, State VA Zip 229o3
'
(i ude suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? ,,in C1l;nr,.;-o,1
U
Address: 2*21 lv� P-cl. 5�:s+e 1Zo City (I�tirl�+ks;ill� State 1(f� Zip 22103
Office Phone: U Cell# 3 gi1-003 Fax# E-mail inellinc�}unC i{,e(in}�eeybr,orq
v
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: -Pe- r1,.0 Tea -fie Bl,,e- R)'&Oje .- j�on �i' ��Pac*clio'1
v
Previous Business on this site QCZvi o 'A.g
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: None Ace ch .,Cull_
r ��n« exe'—m0ok
�o�oNetS
*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 accurate to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed In E.Il;n-- or\
AP OVAL INFORMATION
[ Approved as proposed [ ] Approved with conditions [ ] Denied
[ ]� ckflow prevention device and/or current test data needed for this site. Contact ACSA, 9774511, x117.
[ of NNO 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 c' Date �7✓���
Zoning Official Date �3113/ 1-'x
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 /�
Is use m LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/N
Wi 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 blic water?
If private well, provide Hea epartment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one thatel on septic Cor public sewer.
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit# W0-11 fPtCNf�, SirCr�}� ( fit
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
WaAd i%,Ao e, Sejxlrn�e. Fe ( ^T
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: % f
Y/ p�
Permitted as: Cedlmin�S��u,{'yp, /bllSlnCS.S 0111tQ1
Under Section: L3, 2 - ({
Supplementary regulations section:
Parking formula:
hoo net (G, ' l emnloyep"
Required spaces: Z
Y N
Ite be verified in the field:
Inspector : Date:
Notes:
Viol ns:
Ifs ist:
-7-
pr
If soZ ist:
Va ' ce:
Y/N
If ist:
SP's:
Y/N
If so, List:
(OS-7- 3-7
Clearances: ZrC
IS-6�i CummurwP�l�� g,
SDP's
IC-1 3-7 -3�1
rg'SU -47
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, eiru.nte-, a-Lrolt- io 6e- aSSi cat
ounty application name and number] U
was provided to �osscr i�i.s$vci c��c5
[name(s) of the record owners of the parcel]
and Parcel Number () to 00 a - 00 -- c 0Z s v a
ma er identified below:
E
Hand delivering a copy of the application to
the owner of record of Tax Map
by delivering a copy of the application in the
[Name of the record owner if the record owner is a
person; if the owner of record is an entity, identify the recipient of the record and the recipient's
title or office for that entity]
on 31 1 / 1$
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].
Signai9re of Applicant
J,n �011-ntn
Print Applican ame
3 Ig
Date
Area
94 SF
Area
100 SF
Area
t32 SF
Area
94 SF
Area
i Rig SI
Area
252 SF
FIRST LEVEL
2421 Ivy ROAD
Area
SF Area
117 S(
ELEC
PANEL.
Area
217 Sf
MECH
w
2
Ael
n w, .- 4 kip b� iSk 7�0y y Yr
120
OF
no tF
� � e
i 1 n4
P+ r ELECTRICAL PANEL Ir
Alen rt ry r ,'-.�, �yi k H r�' y i' to
334 S( ��`
'i a
4µq Yhti f}
iI
Y r. 4
I 2 3
Area Flrea Area
77 SF 75 SF 76 SF
Area
153 �F ELEVATO
MECH RI
i � 51 SF
MECHANICAL RM
232 SF