The URL can be used to link to this page

Home My WebLink AboutCLE201000067 Review Comments Zoning Clearance 2010-07-19Application for Zoning Clearance CLE# 210 -67 ., < Zoning Clearance = $35 PLE REVIEW ALL 3 SHEETS OFFICE USE ONLY Check # 075 Date: Receipt # 7 SwS Staff: PARCEL INFORMATION Tax Map and Parcel: (') U B S "UCH — U 0d 001130 Existing Zoning Parcel Owner: 9 (}aFS'r f— L85 l o j(50 Parcel Address: 1�Sf yj1? ft( i E tateV Zip 72 (include suite or floor) PRIMARY CONTACT ` Who shouldwe call /write concerningthis project? M Address: 'T� (Joc��1L�i 65 10 City Cf[ULon'ES✓�LLL State Vs —zip 22-'7y/ Office Phone: 11 '1 0 q4-6-11S4? Cell Fax # E -mail APPLICANT INFORMATION -s Check any that apply: Change of ownership Change of use Change of name New business Business Name /Type: Previous Business on this site 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: *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 �bbest ti, my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them. Signature Printed �}� r1 i •�-Q( J APPROVAL INFORMATION Approved as proposed [ ] Approved with conditions [ ] Denied ] Bacicflow 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 L% -`� z�"--� Date Zoning Official Date Other Official Date County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 Re ised 04/28/08, 10/13/09 Page 2 of 3 Intake to complete the following: Y / Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y /I Will sere 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 of public�s' er? If private well, provide Hea I_ apartment form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that -ap- 'es Is parcel on septic public sewer? Y/ Wi ou be putting up a new sign of any kind? If so, obtain proper Sign pen-nit. Permit # y / Will e be any new construction or renovations? If so, obtain the proper Permit. Permit # 7nninor to emmnlpte the fnllnwinu- Reviewer to complete the following: Square footage of Use: Y/N L/ Permitted as: T ,Q WOP/ Under Section: Parking formula: Required spaces: Y/N Items to be verified in the field: Inspector: Notes: Date: Violations: Y/N If so, List: Proffers: Y/N If so, List: i i Variance: Y/N If so, List: SP's: Y/N If so, List: p I I I Clearances: SDP's Revised 04/28/08, 10/13/09 Page 3 of 3 CO r r (N c; TTI pp fA Gn. LA LA p t i ! 3 ti p t i ! 3 Sunday, May 2, 2010 Check -in 7:00 -7:30 am Race start: 8:00 am Packet Pick -Up: All participants are strongly encour- aged to pick up their race packets on Saturday, May 1 at the Forest Lakes South Club House from 5:00 - 6:00 pm and attend an important pre -race information and safety meeting at 6:00 pm. Register early - Race limited to 1st 200 applicants This event is expected to fill, so please be sure to enter ASAP if you want to participate. NO RACE DAY REGISTRATION 1 Forest Lakes South Swim Club 1650 Ashwood Boulevard Charlottesville, Virginia MAW, Ages 7 -10 will compete in the fol- lowing distances: • Run: 1/2 mile • Bike: 2 miles • Run: 1/2 mile Ages 11 -14 will compete in the fol- lowing distances: • Run: 1 mile • Bike: 4 miles • Run: 1/2 mile Female / Male: 7 -8, 9 -10, 11 -12, & 13 -14 Age on race day determines age group • All finishers will receive an award • Lots of cool door prizes ! $30 through April 11 $35 afterApril 11 NOTE: Fees above include a $5 fee for one -day USAT membership. If participant is already a USAT mem- ber, this $5 fee is not required and the participant's USAT# and expira- tion date must be provided on the application below. IMPORTANT, Mail -in registrations must be postmarked by April 23. Make checks payable to: SOCA Mail completed application below with payment to: Dogwood Youth Duathlon 1634 Thornridge Way Charlottesville, VA 22911 Completed applications may also be hand delivered to Ragged Mountain Running Shop through April 23. CUT ALONG LINE BELOW. COMPLETE BOTH SIDES OF FORMAND MAIL WITH PAYMENT. RETAIN TOP PORTION - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Name (Last) : (First): (M.I.): Address: City: State: Zip: Phone: Age (on race day): Sex (circle): Male Female Email address: What school do you attend ?: Emergency contact / relationship: Phone: T -shirt size (circle): Youth Med (10 -12) Youth Large (14 -16) Adult Small Adult Med Adult Large Would one parent be willing to volunteer on or before race day if needed? (Y /N) If yes, how to contact you? Application Fee: ($30 through 4/11/10): Application Fee: ($35 after 4/11/10): USAT member? If yes, subtract $5 and complete: $ USAT# Expiration date: Total Fee Enclosed: $ $ Make checks payable to: SOCA Mail completed application & payment to: Dogwood Youth Duathlon 1634 Thornridge Way Charlottesville, VA 22911 * * * Important; Please read & sign waiver on the back of this form * * * ; dta/ 6! ��J 9 �C i ry 'dd � A fL tatt ✓Y/ VY✓k M-ga o. T'Q� h4, S4 4% A ,y From Charlottesville: Take 29 North to Ashwood Boulevard and the entrance to Forest Lakes South. (Traveling north on Route 29, Ash - wood Bloulevard will be the second traffic light afterthe entrance to Wal- Mart and Sam's Club.) There will be a large green sign at this intersection which reads: FORESTLAKES South Entrance. Turn right on Ashwood Boulevard After turning, proceed .7 miles. The Forest Lakes South Swim & Ten- nis Club will be on your left. Email: Jenn Corbey - jenniferco @acac.com Kim Starr - kims @acacpt.com Phone: Jenn Corbey (434)249 -0795 Wt • The run and bike course will be in the neighborhood near the pool. • Maps will be included in pre -race packet. • NO drafting is allowed on the bike. • NO interfering with other competitors. • NO running is permitted in the transition areas. • Helmets MUST be worn at all times on the bike and must be ANSI and /or Snell approved. • Participant must have parent/ guardian on site during the event. It is the mission of the race committee to provide a safe, healthy environment for this event. The primary objective for this race is for it to be an introduction to friendly competition with an emphasis on enjoyment of exercise, good sportsmanship and personal fitness. The race director reserves the right to postpone, alter or cancel portions or all of the race as deemed neces- sary for safety at the race director's sole discretion. There will be no rain date. ** NO REFUNDS ** – — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — WAIVER AND RELEASE: The parent /guardian makes these representations on behalf of the Minor participant. I know that participating in biking- running duathlon events are potentially risky and hazardous activities. I represent that participant is medically able, properly trained, and in proper physical condition to participate in this event. I assume all risks associated with this event including but not limited to, falls, contact with other participants, weather, high heat, humidity, the conditions of the road, pool, trail, facilities, and traffic on the course. I agree to abide by the decisions of the race officials on all event matters including participation. I will supervise Minor at all times and I am responsible for Minor's safety and health. In consideration of your accepting this application, I, for myself, Minor, and anyone entitled to act on my /Minor's behalf, waive, covenant not to sue, and release the Releasees, listed below, from all claims or liabilities of any kind arising out of my /Minor's participation in this event. I do so even though that claim or liability may arise out of negligence or careless- ness on the part of the Releasees. I indemnify, save and hold harmless each of the Releasees from any litigation expenses, attorney fees, loss, liability, damage or cost that may occur as the result of such claim.- The Releasees: All sponsors, organizers, race directors, race committee and volunteers of the Dogwood Youth Du- athlon, Forest Lakes Community Association, Spring Ridge Community Association, and each of their agents, servants, officers and employees. I HAVE READ AND UNDERSTOOD THIS WAIVER AND RELEASE Parent/Guardian (print) Parent/Guardian Signature Participant/Minor (print) �. ° a a,, �c,, a ,.r � ors �'• � 000�o�' >r �� N �,� °tea a�• r. `� Q4 aroma �� kl"ol G rinoN a 0 lt' j -. `".. �z Jo- Yyw O On � Y. �t7�ilgy�YGr! i �.i M u