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Home My WebLink AboutCLE201900159 Approval - County 2019-07-18Application for Zoning Clearance CLE #_.�o q h OFFICE USE O Y PLEASE REVIEW ALL 3 SHEETS Check # Date: ' Receipt # Staff: PARCEL INFORMATION p Tax Map and Parcel: 04 1 ro { --00 —o Leo Existing Zoning 6 V Parcel Owner: Sutherland Middle School Parcel Address•2801 Powell Creek Dr City Charlottesville State VA Zip 22911 (include suite or floor) PRIMARY CONTACT Who should we call/write concerning this project? Devon Byme Address :401 McIntire Road, Human Resources City Charlottesville State VA Zip 22902 Office Phone: 4( 34 ) 296-5827 Cell # 5026640341 Fax # E-mail dbyrne@Walbemade.org APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name / New business Business Name/Type: Charlottesville -Albemarle Employee 5K Event 11/16/2019 Previous Business on this site Describe the proposed business including use, number of employees, number of shifts, available pa rng sp es, number of v rcles, and any additional information that — �Q you can provide.--Me,Ca t Ui 1W n *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 Devon Byme A,PPfitOVAL INFORMATION [44pproved as proposed [ J 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 sitee„compiie�s�with site as o�}f{t-hi{e",a}te. ,the �p'�f�,n Notes: �d�t-1 F� 1 l Building Official Date Zoning Official Date Other Official — Date Uounty 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 / N Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y/N Will there be food preparation? If so, give applicant a Health Department fo /m. Zoning review can not begin until Zater? ive approval from Health Dept. FAX DATE Circle the one that applies Is parcel on private well or public. If private well, provide Health Department form. Zoning review can not begin u 1 we receive approval from Health Dept. FAX DATE Circle the one that applies / Is parcel on septic or pu is sewer? Y/N Will you be putting p a new sign of any kind? If so, obtain proper Sign permit. Permit # Y/N Will there b any new construction or renovations? If so, obta' the proper Permit. Permit # Zoning to complete the following: Reviewer to complete the following: Square footage of Use: Permitted as: Tt If l P Under Section: Supplementary regulations section: .�-- Parking formula: ', . kA Required spaces: Y / ItemWo be verified in the field: Inspector : Date: Notes: ViolD'ns: Y so,t: Proffers: Y /If Ifst: Var' e: Y� Ifs st: SP's- Y Ifs ist: LS Clearances: c.�E � ITS• aq SDP's N l t. 7R r1 � inn Revised 11/1/2015 Page 3 of 3 1521 Hurts Labe D ES 1523 p,�berf1vIrrI)r FOREST LAKES t r� H 0 L L Y M E A D Y•� �b,r�3 1525 ,�e Rd -�inker5GO 152�' Hollyn Elementary Sc ,"harwid9e W" 1523 ^'9 P , P P � P j / J'• / 1 Id of 'Wddile mer Y. Sutherland ' School ; Forest Lakes South Pool- National Poor F0RL',ST LAKES Si+DUTH �1 April 1, 2017 DOTVirtt;ttia u4j.Plir grit ?ti Tr;;ntiprsrtrttinn Land Use Permit Application (LUP-A) APPLICATION is hereby made for permit as shown on the accompanying plan or sketch and as described below. Said activity(s) will be done under and In accordance with the rules and regulations of the Commonwealth Transportation Board of Virginia, in so far as said rules are applicable thereto and any agreement between the parties herein before referred to. Where applicable agreements may be attached and made a part of the permit assembly Including any cost responsibilities covering work under permiL Applicant agrees to maintain work in a manner as approved upon Its completion, Applicant also hereby agrees and Is bound and held responsible to the owner for any and all damages to any other installations already in place as a result of work covered by resulting permit. Applicants to whom permits are issued shall at all times Indemnify and save harmless the Commonwealth Transportation Board members of the Board, the Commonwealth and all Commonwealth employees, agents, and offices, from responsibility, damage, or liability arising from the exercise of the privileges granted in such permit to the extent allowed by law. In consideration of the issuance of a permit the applicant agrees to waive for itself, successors In Interest or assigns any entitlements it may otherwise have or have hereafter under the Uniform Relocation and Assistant Act of 1972 as amended in event the Department or Its successor, chooses to exercise He acknowledged right to demand or cause the removal of any or all fixtures, personality of whatever kind or description that may hereafter be located, should this application be approved. Driver's License or Tax ID No. 54-6001102 Owner Name Albemarle County Public Schools, Human Resource Address 401 McIntire Ave City Charlottesville State VA Zip Code22902 Driver's License or Tax ID No. Owner Name Address City Contact Name Devon Byrne E-mail Address dbyrne@albemarle.org Telephone Number 43429652827 Emergency Telephone Number 5026640341 Fax Number 4342965828 Contact Name, E-mail Address Telephone Number State Zip Code Emergency Telephone Number Fax Number Permit Term Requested 1 BO days Fees Enclosed $ Check Number Money Order Estimated cost of work to be performed on VDOT Right of Way $ Surety Information: Surety Posted by: Owner DAgent County Resolution Walved if cashlcheck surety is posted, please complete Bonding Company Name Bond # Commonwealth of Virginia's Substitute Form W-9. Irrevocable Leiter of Credit - Bank Name Irrevocable Letter of Credit # Surety paid by Check - Check Number Amount of Surety $ Obligation Amount $ Request Permission to perform the following actiyitV(s): Charlottesville-Atbemane Employee 5K to benefit the Public Education Foundation Location: W County ❑ Town ❑City of Albemarle Between Route No. Street Name Ashwood Blvd as per attached plans. Route No. Street Name Powell Creek Drive and Route No. Street Name Powell Creek Drive Latitude Longltude Tax Map Number Applicant Job No. Applicant shall provide proof of registration as an operator with the appropriate not itication cantor Inaccordance as defined in §2.2.1151.1 of the Code of Virginia & must provide a not aflaed affidavit, stating that the utility owner has notified the commercial and residential developer, owner of commercial or multifamily real estate, or local government entities with a property interest In any parcel of land located adjacent to the property over which the land use Is being requested, that application for the permit has been made, aIF APPLICABLE, I AGREE TO PAY THE FULL SALARY AND EXPENSES OF A STATE ASSIGNED INSPECTOR IN CONJUNCTION WITH ACTIVITIES AUTHORIZED UNDER THE AUSPICES OF A VOOT LAND USE PERMIT. By signing below, I ack�Mr cognizant off all the LUP-SPG requirements associated with the issuance of a VOOT Land Use Permit, Signature of Applicant/ `' `—�Title Event Director Date 7/15/19 Signature of Agent:Title Date All applicable items on this form must be completed to avoid delay in processing the issuance of a VDOT Land Use Permit. Prepayment required with remittance payable to Treasurer of Virginia. Receipt is hereby acknowledged for: CHECK No.: In the Amount of $ Authorized VDOT Signature: VDOT USE ONLY for PERMIT FEE $ 'Agent mean: Applicant contractor's or a person or business authorized to act on another's behalf. MONEY ORDER No.: CASH SURETY $ Date: