HomeMy WebLinkAboutCLE201800078 Approval - County 2018-04-20210IV
Application for Zoning Clearance_°
19m
CLE # (j / 41
OFFICE US N Y
PLEASE REVIEW ALL 3 SHEETS
Check #%Qib Date:
Receipt # .Z Staff: �v S
PARCEL INFORMATIO
Tax Map and Parcel: I $ 77,C) (A_ Existing Zoning C 0
Parcel Owner:_Wk (�C—A-L, R-1-6 1_0 N n AM d 4
Parcel Address: - 10(3 �J Q (L(Z,FU- O K WE' City C V (LLC% State V /!N- Zip Z:24
(include suite or floor)
PRIMARY CONTACT
rr h /
Who should we call/write concerning this project? V c 1U fC Lk P ('V
Address : l0 0 Uy Q 0 4F L-L O k (f f IF City C V I L t-(7— State VA- Zip ZZqy
Office Phone: t �» ► _7iy`1 -brt3 `l Cell # 71 y5 L Fax # Z``[`1 - a L3S E-mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: K LU (nt -12 N tfE "o o w t,,tq--L �� ('a Cit 0 AI rc t— vl ✓",-
Previous Business on this site % IU(LEL-L F rJT (L X (2 (S E r
Describe the proposed business including use, number of employees, number of shifts, available parking s�Paces, number of
vehicles and any additional information that you can provide: 0 L" t d f,o U --+ A n d 71 d d L
%a u
V NI 6 h J t A c Z 1 m j A-sk qAA + IZ O fj
*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 ethe best of my kpnowledge/i have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed_ L U p( A-/
AP OVAL INFORMATION
[ A oved as proposed [ ] Approved with conditions [ ] Denied
[ ] ackflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, x117.
[v' 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 / 9
Zoning Official r,-- Date
Other Official Date
%.uuuLy vi Hiuemar►e impartment 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:
Is/
Is UO LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y /
Will 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 or ublic water
If private well, provide Health epartment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one gt applies
Is parcel on er public sewer?
Y, )
Wil you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y /
Will ere 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: I S i L, - `~
V N
Permitted as: /�►r[ �s� �- r.. I��ii rn�
Under Section: Z 3 • ?
Supplementary regulations section:
Parking formula: ' l
Required s aces:
Y �. N- �S
Items to be verified in the field:
Inspector : Date:
Notes:
Viola 'ons:
Y /NJ
If so, ist:
Proffers:
Y/ N
If so, List:
Var�jail�e:
Y/Iq
If so, List:
SP's:
Y/
If so, ist:
Clearances:
SDP's
Revised 11/l/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, 7i bl 1 r. 1, Q D If ✓ K In U
[Couigy application name and number]
was provided to it Fr ", I&V A- Fv tx Ai "o J the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number 1 1 1 L V 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
Mailing a copy of the application to TK k MJ k h)U 0 6 flnj-"j r b A f
[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 ; / 7, [0 l l ¢ to the following address:
Date
[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].
4A -1VWJWCA
.
Si tore of Applicant
L, &14 ft N M &L.Ae (6l
Print Applicant Name
3'Zco�l�
Date
_ - &A PL
F.