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Home My WebLink AboutCLE201100161 Review Comments Zoning Clearance 2011-09-14Application for Zoning Clearance- : "✓ "'Y� OFFICE US ONLY � PLEASE REVIEW ALL 3 SHEETS Check # 0 Date: Receipt # Q P Staff: PARCEL INFORMATION Tax Map and Parcel: '7M U S) `i 5- GR 0 Z- Existing Zoning Parcel Owner: 64 firs Cw0 o Parcel Address: 0 City Ck ALM � — State V /T Zip Z I 1 (include suit floor) PRIMARY CONTACT �AVSTriA1 -°VALE Who should we call/write concerning this project: tT�4 ' / A(I(Iress : 3� ► ' �7 +� w CityC��Vl� state V 'Lip 2� �-� office Phone: (q A 2 $•IQgs Ccll #�3q.13y2.'`g2- [Fax # E -aril Yt-, jj5t -ev- 'thC.I.OA APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business BusinessName/Type: !Eu r21 5(y� ?P1 d C� fi' (�/ �[I l Previous Business on this site Describe the propose([ business including use, number of employees, number of shifts, available parking spaces, number of vehicles, and :1 fly 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. it new Zoning Clearance will be required. I hereby ccrtily 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 1 understand; them, and that I will abide by them. Signatut ( "--- -� Printed TIf'C,.� {LCt, sfyn APPROVAL INFORMATION [ ) Approved as proposed [ ] Approved with conditions [ ] Denied ( ] Backflow prevention device and /or current test data needed for this site. Contact ACSA, 977-4511, x 1 17. ( ] No physical site inspection has been done for Ihis 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 I Zoning Official Date Other Official VD W ) Date - County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 Revised 7/1/201 1 Page 2 of 3 V /LL9 Intake to complete the following: Y/N Is use in LI, I-II or PDIP zoning? If so, give applicant a Certified Engineer's Report (CGR) packet. ,g ttnOJ Y /( n Ll �pre( s an Will there be food preparation? t� ((64ned but'int If so, give applicant a Health Department form. P"P°" N S Zoning review can not begin until we receive approval from Health Dept. FAX DATE Reviewer to complete the following: Square footage of Use: Y/N Permitted as: Under Section: Supplementary regulations section: Circle the one that applies Parking fornula: Is parcel on private well or public water? If private well, provide Hea i t epartmeni form. Zoning review can not begirt until we receive approval from Hcalth Required spaces: Dept. FAX DATE Y/N Circle the one that applies Items to be verified in the field: Is parcel on septic or public sewer? it ccrn 'BuJ -can ✓t�jttit to rLrrt if�a N lot. Qjt ] '&1 Nor 4 I�e��ttsZd, 'ill you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Inspector : Date: Y N Notes: it re be any new construction or renovations? Ifso, obtain the proper Permit. Permit # Zoninv to comnlete the followinfy: Violations: V/N II'so. List: Proffers: Y/N Ifso, List: Variance: Y/N If so, List: SP's: Y/N If so, List: Clearances: SDI "s Revised 7 /1/2011 Page 3 of 19 LU V UL I pr fl 4j U, 7 zJ L) VI -7- Ll A CERTIFICATION THAT NOTICE OF THE APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER Tltis form must accontpanp 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, g pel i cop cr, .+fi t C�ayv-nco- [County application name and number] was provided to 5%{'i,A.S cku-b the owner of record of Tax Map [name(s) of the record owners of the parcel] and Parcel Number I'M 45 45, &Tg , 2 by delivering a copy of the application in the manner identified below: + I-land delivering a. copy of the application to C;b be-(�� [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] Oil t' Ib' ) i Date Mailing a copy of the application to [Name of the record owner i f 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] Oil 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 teal estate tax assessment books or current real estate lax assessment records satisfies this requirement]. t(�r �{2 tn2Q - I igH ureofAppliCant - - -- -- yt -70�(.!. �rCcS 0. M �� I , �i�L .q,Uj t- Print Applicant Name �b ��S �� 2trYVltSffLGY� %�t.G1C ,fit" � Y�h1Urz5� i bor7�.5 Date i'e,l t:u4•eC9 � `�(n2- ''?N� -� u.v�ci � W W.. Coo t � � ,,LS CUAAkA 0_ C" �vf ��(, a pe,�r�ll� -sc,ap n l�tGcticvt1,t.cm� �Cam - � . Savings Made Simple Dear Albemarle County Police Department, On Saturday, September 17, 2011, Albemarle County Police Department will be using Sam's Club parking (backside). This will be an all day event and all event attendees will be all to use our restroom facilities. If you have any questions or concerns please contact Jeffrey Pugh or Whitney Baril at (434)978 -2122 or by email jspugh.06365.us @samsclub.com Thanks, Whitney Baril Member Service Assistant Manager Sam's Club 6365 THOMAS JEFFERSON HEALTH DIStRICT P o BOX 7546 CHARWTTESVILLE VA 22906 ,434972-4310 FAX 434 - 972.6219 (PHONE) FaX Plwotwp �� 3 Phoh c (434)972- CC: (434)972 -4310 FAX tlrpent U For RwWow ❑ Nlw Conmmpd ❑ Place R ply ❑ Plame Recyclo r C0"wn Si ��-) % nU o4 SA,.: The documents accompanying this telecopy transmission contain confidential irfmapon belonging to the sender which is legally privileged. The information is intended only for the use of the'individual named above. if you are not the intended reciplerd, you are hereby notified that any disclosure, copying, distribution or the taldng of any action in reliance on the contstb of this teleaopied informahion Is strictly prohibited. If you have received this telecopy in error, please notifjl fire sender by telephone Immediately. Thank you. Z00/L00'd 99LL# 0l :9L LLOUCL /60 Application for Zonxn Clearance CLF# 0lool�e OFFICE US NUT PLEASE REVIEW ALL 3 SHEETS Check 0 Buie: Receipt a Starr PARCEL INFORMATION lax Mnp find Parrcl: 'TM U S- - Fp Z Esia(ine Zonlnl! Pitecel Owner,._64&t CLUIG (e, D 4, Hm N %r3 CRY �V1C Slntc zip parcel Addrrss: s --#-I (lnclutle Aulte or floor) PRIMARV CONTACT q�p mot-° �G' w'ho sifoultl we cowwrlte concerning this proJecl7 t l A r�1 tn Clty�l LL0' Stc 1� Z1 p Z 0 Addmn: 30q� �+, SW / afflce I'hor+e: (�ZgS.l4$S Ccllf�g3q.1F7;'3'`C2J f{434- AIS 'R3 �mnll Yr,1Lj5ty�&rtht'fot1'�L t APPLICANT INFORMATION Check any flint np 1 : a ormvnership CltlIenge of uAC Cltnnge of nun +e New business ��C-^hun 11 business Nnme/Type: ZD - Previous Drrslrress on tills site Describe the proposed business including use. mmilm'r oremptoyees, nombar orshiRs, nvolnble psfrking spaces, number or vehicles. Intl uuy,ndclitiounl lnlbrinittion (hill You call provide: "Ilfis Clerimoce will an1), be yillid an the parcel lbr which It Is upprvved. If you cltunbe, iniensiry or niavc the use to a new localio,,, a t+cw T,ot+ing CLenrance 1011 1,0 required. r hereby ecniry lhal I avn nr HAva the uWIW.es permisaioil to use the splice lndieuled on dils npplieatiun, it altsa ccttiry Ihul the inlbnnGllon pcvsidcd knowledge, r Hoyt nsnd the candiddns of approval, and 1 undersimid; Own), and 4,at I +vill abide by them. is true and a�curute to the beat uruty • Signmui� c%�— = _Printed, 1�� (`�� APPROVAL INFORMATION Denied I Approved its proposed C J Approved with conditions ) tcsl duta needed for this site. Contact ACSA, 977 -451 1, x117. ( .J Daekllow prevenlloi) device and /or current r 1 No pliysienl site Inspection leas been done for this ck+rauce. Therclbee, it is not a determination ofcompliance with the cxlxling site plen. ( ) Thls site complies will, this site pin,, as or Q +Is dale, Notes: 111jilding Orftclnl We zoning Official llnte g�tltl othtrorrriltl ;.ten �� t• �� t� ante County of,Ubernurle Department ar Community DcvcloprnenC 401. NIclnllre Road Cho rioticsville, VA 21902 voice: (434) 2% -5832 Fail: (434) 972 -4126 Revlsed7 /1/2011 Page2of3 vltg zoo /ZOO'd 99{L# tl:91. I1.0UGL /6o