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HomeMy WebLinkAboutCLE201200122 Legacy Document 2012-07-10Application for Zoning Clearance CLE # .;Zb Z- 1 a PLEASE REVIEW ALL 3 SHEETS OFFICE USE ONLY Check # Date:" Receipt # Staff: Vii PARCEL INFORMATION Tax Map and Parcel: �- fi0 G o i5 0 1 Existing Zoning Parcel Owner: �'� 1' n d' L- c 1 Gk A) V I-I ([j i✓ c° t4 Address: 0 �� -S e eh ► Wd e tfu (City C Ue ( 6 / aS`t�t�e l!r Zip '2 2g II Parcel --c (include suite or floor) PRIMARY CONTACT Who should we call /write concerning this project? % I f N f S t,✓ Address: 2-3 d t{ [Gt l� C City L Gt ��� ►7c����(C State V �i Zip Office Phone: 6l31 q*7�- f 3q � Cell #' t 3Y 40 '-2t' ©ax # ti4t( 475- aftll- E -mail �� 0 i' 5��� �/ a o �, /'A0 Ij APPLICANT INFORMATION Check any that apply: Change of ownership Change of use k Change of name New business Business Name /Type: � j a 111 (' c /,� ill fit, u ku J` C OUYL/ S /C)/ C. t Previous Business on this site rx Nv �� S r ° v 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 � e jbest of my know led e, have read the conditions of approval, and I understand them, and that I will abide by them. .� �� Signature `1' V' Printed � '-C' V o ` �✓ /'� L g APPROVAL IN ' ORMATION [ ] Denied [ ] Approved as proposed [1,j Approved with conditions [ ] 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 si complies with the site pan as of his d �. Notes: Vot �- Date Building Official Zoning Official Date ;L Other Official Date / to a County of Albemarle Department of Uommun►ty iieverupruenr 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 Revised 7/1/2011 Page 2 of 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. /N ill there 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 pbpIies Is parcel on privat or public water? wel If private well, provi ealth 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 or public sewer? Y /t. N•ll Will cfu be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Y b Will t ere be any new construction or renovations? If so, obtain the proper Permit. Permit # Z ' t com lete the Win in - Reviewer to complete the following: Square footage of Use: i�O i (Y /N Permitted as: ( V 8" giw Under Section: _ /b .2 •1 Supplementary regulations section: acJti L„ Parking formula: Required spaces: Y/ Items to be verified in the field: Inspector : Date: Notes: onm o Violations: Y If so, ist: Proffers: Y/ If so, ist: Variance: Y/ If so, ist: SP's: Y/D If so, List: Clearances: SDP's Revised 7/1/2011 Page 3 of 3 J � e O' 0 ---- 3 �' _. __ __ __ 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. ' d -ecc f(z 0, C, G I certify that notice of the application, C c� C �✓ T 2 v `v :, 6 [ o ty application name and number] was provided to t�l T �� 4 jN e�, the owner of record of Tax Map [name(s) of the record owners of khe parcel] and Parcel Number 0 Z ( Q pood 1-7, D by delivering a copy of the application in the manner identified below; Hand delivering a copy of the application to P6; � / ('1D P [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 "Z 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 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 real estate tax assessment books or current real estate tax assessment records satisfies this requirement]. 4 Signature o Ap licant Print Applican Name r— Date - - - ...-Application for - Zoning - Clearance- .-- - - -.- -- -- .w r, CLL # ' D Q 1T.1 PLEASE RE, VIEW ALL 3 SHEETS OFFICE us E ONLY Checl< i a l ak Dntc: Receipt # Stnfft PARCEL INFORMATION - Tnx Mnp and Parcel: AIIL' 00 0010 0 1� A 0 Existing Zoning __ ' I Parcel Owner: � l I l\ I d L- 1 G Vl A vii V J-1 W t/ Parcel Address; (� G -S t'r� t IvG�etfct,'Clty C L Ut/ 66 /6ss` If�e �/T Zip 'Z 2� f (include suite. or floor) PRII '1ARY CONTACT �� �'S �� ��� Who should we call /write concerning this prroject? ft ✓r`/ �� Address; .S4 Clty r___(1G( j flr)VXe State. V 0t `Lip Office Phone: 'l, q'7� ^ F3 Cell # t i . a'2� � IX # t1jl(- g7)'6rY72- R -innil APPLICANT INFORMATION Ch eel( nay that apply: Change of orvrtershlp Change of use. \, Ch ;trigs of name New business lN(ur ' fi � C oujv S Business Nnntc /Type; ct tvo� _�S t , Previous Business on this site "u rA lv'_ Describe the proposed business including use, number of employ eesVituinber of shifts; nvailsl ie parking sparest it u rib0r of vehicles, and any additional Informat!on that you can prov"idet "This Clearanoewill only be valid on the parcel for which it is approved. If you change; intensify or move the use to a new location, n near; Zoning Clearance Will;be. required, I hereby certify that I own or )rave file owner's permission to usethespnee indicated on Allis application. I also certify that the infomnation provided Is true and gccurate tp t ie est of my knOwledge,�[ have read the conditions of approval; and 1 understand ther)L and that I will1abide by them, /�I 1J 0 1/ L✓A��� Signature V( Printed Vi ` T APPROVAL INP ORMATION [ ] Approved as proposed X1 Approved with conditions [ ] Denied J Backtlow prevention.device andlor current test data needed for this site, Contact ACSA, 977-45 11, x117. [ J No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing site plan, [ J This site complies with the site plan as of this cinte, Notes: Build hig Offiphol . v - �� - �= o Date Zoning Official Date Other Official - I is County of Albemnrle Deportment ol" G.:onununtty Development 401 h1clndve Rond Charlottesville, VA 22902 Voice; (434) 296.5832 Pax; (434) 972 -4126 Revised 7/1/201 i Page 2 of 3 Rebecca Ragsdale From: Kirtley, Joshua (VDH) [ Joshua.Kirtley @vdh.virginia.gov] Sent: Friday, July 06, 2012 4:25 PM To: Rebecca Ragsdale; Stewart Wright Cc: Batten, Teresa (VDH) Attachments: HaneysMarketApprova 106July12.pdf Rebecca: Good afternoon. Hope you're doing well. Attached is a copy of the Zoning Clearance for Haney's Market. I am comfortable with the clearance provided the following conditions are met: • The applicant maintain licensure with the appropriate authority regarding food preparation (if applicable) • Menu items and water use figures stay roughly the same as past uses If you have any questions or concerns, please let me know. Have a good weekend, Josh Josh KirtleyI Environmental Health Specialist, Senior Thomas Jefferson Health District I Albemarle County, Virginia 1138 Rose Hill Drive I Charlottesville, VA 22903 434 - 972 -6288 1