HomeMy WebLinkAboutCLE201800119 Action Letter 2018-07-18Application for�Zonin� Clearance 1, N`r_
CLE #
OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS 1 Check # � Date:65`111' 1% j
Receipt # Staff:
PARCEL INFORMATION
Tax Nlap and Parcel: (� U 1 M N 0. r 0x6isting Zoning qhvvad
J,
Parcel Owner: q� �� Ld—)
Parcel .Address: �2� UxAb City wo#�Sv1 tit— State � �C Zip7z1o2_ I�
(include suite or floor)
PRIMARY CONTACT
Who
Who should we call1w}rite concerning this project? � e
Address : f� C% 15(X� ���P�� I _ City C�_l�h M.V_ State A Lip ZZgoZ
Office Phone: `• L/ 3Z�GS8s 2((asalar ,Ma�� • c o
( ) Cell #r h ax # E-mail
APPLICANT INFORMATION
_Check any that apply: Change of ownership Change of use _ Change of name New business
Business NameiType:
Previous Business on this site O Y V 0.S V ap e Sk9�e
Describe the proposed business including use, number of employ
vehicles, and any additional information that you can provide:
number of shifts, available parking spaces, number of
*This Clearance will only be valid on the parcel for which it is approved. If yoti change, i
Clearance will be required.
1 hereby certify tha 1 own or have the
is true and accur,eo thc�est cA Illy I
Signature
move the use to a new location. a new Zoning
n s pen issiou to use be space indicated on this application. I also certify that the information prm id, a
vledge have read the onditions otapprm al, and 1 Understand then-,, and that I will abide by them.
Printed
APPROVAL INFORMATWN
Approved as proposed [ j Approved with conditions [ ] Denied
[ Backilow prevention device and/or current test data needed for this site. Contact ACSA, 977-45 t 1, x1 17.
j ] No physical site inspection has been done for this clearance. Therefore, it is not a determination o! compliance w ilh the existing
site plan.
[ f This site complies with the site plan as of this date.
Notes:
Building Official
Zoning Official
Other Official
Date
Datef
Date
County of Albemarle Department ofCommunity Development
401'iclntire Road Charlottesville,' .11, 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
Hcviscd 11 02i2015 Pagc 2 o1 _
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 lQtere
Wilbe 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 o
Il'private well, provide 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 septic o ublic sewe
Y / N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign pernut.
Permit #
Y / N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7.onin¢ to comnlete the followinu-
Reviewer to complete the following:
Square footage of Use: I 6S-1 —
N
utted as: be -1 b 6 ela ,S 1 + �✓
Under Section: 2 Z� Z - ( 6, 1
Supplementary regulations section:
Parlung formula: tt
i S r et (C-0, zoo �Wc fT of 1ti/S 1 loo c u rs61
p 4,r I pe— .e
Required spaces:
Y
Items to be verified in the field:
Inspector : Date:
Notes:
I
Viola' ns:
Y /(N J
If so, ist:
Proffers:
Y
If soost:
i
Variance:
Y /M1
If so, tst:
SP's:
Y N
11'so, List:
I
Clearances:
SDP's
I
I
I
Revised 11 1 /2015 Page 3 of 3
CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
This fiorm 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,
was provided to
[County application name and number]
[namc(s) of the record owners of the parcel]
and Parcel Number
planner identified below:
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
Date
0 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 satislics
this requirement].
Signature of Applicant
Print Applicant Name
Date
Room Size:
341"x796'
KEY:
EO - OUTLET
P- Plumbing Fixture
722Rio West #7 Original Floor Plan
Store Front
341"
V/0(9052d
722Rio West #7 Floor Plan
Room Size:
341 " x796"
KEY:
EO - OUTLET
P- Plumbing Fixture
Store Front
341"
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