HomeMy WebLinkAboutCLE201800113 Approval - County 2018-07-24<'aP?ROVED
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Application fore Qr0Mge aranceCLE
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OFFICE
PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: 0'7 2 cy - 0,0 - U0 ` 0 1-10 (o Existing Zoning
Parcel Owner: K.k VO(a 4 J)" 12
Parcel Address: a(,<) Pa-1-40 P3 C,L� City C , V-- 1(x State �� ;'�- Zip 2241 1;�3
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? �, „-% C ( c S "A --�C LJ2- 1- +
Address : � 6 (0 ZP City kj S-A : c/11_ Statey' 4 Zip2.,2y47
Office Phone: # Cell ` 72_L Fax # E-mail U � � l VI 4) iP 1-F G)
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APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: t v�•l=' 1L N-�
Previous Business on this site
Describe the proposed business including use, number of employe s, num� of shifts, available parking spaces, number of
vehicles, and any additional information that you can provide: ;�(4
*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 accurat 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 �1 ✓x G� c it i— Z''
APPWVAL INFORMATION
[ pproved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, x117.
[ ] 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 C
Zoning OfficialZ91Z_X.1b Date � as
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
v
1
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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, O 1 -- , n 1 eo_ ate, C_ �
[County lication name and number]
was provided to P 11 r,_,,4, 1 1 the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number 0-7 J0 0 - 0 0 - 0 ti-- 0 f -10 6 by delivering a copy of the application in the
manner identified below:
QHand 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
[Name of the record owner if the record ow 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 Q - I to the following address:
Date
0. CA-.e--- to '-qC S v, t Uy A Z zCY 3) ?
[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
Date
t'1