HomeMy WebLinkAboutCLE201200096 Legacy Document 2012-08-09App hi—extion— for Zonlpg-C It aramwe
CLE #. �JQ ORD
OFFICE USE NLY ttN�'Vl
PLEASE REVIEW ALL 3 SHEETS
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Check # ate
Receipt # Staff:
-PARCEL INFORMATION---------
Tax Map and Parcel: Existing Zoning
Parcel Owner: Ic" PY
Parcel Address.101___B W_-C1eY_C1 City Chs,(Vff-j,-51r, I k-State V6 Zip Q�
(include suite or floor)
PRIMARY-CONTACT - - - - -- ____ -_ --- - -_ --- -- -_ --- ____ - - - -_ --- - ____ - - -_ --:- - --- -_ --- --- -
—ry
Who should we call/write concerning this project? - i �- -, ki C,= v e -)
Address --P- 0 :6DY-- _CityiChc-J��l (--( tate YA zip
4-*- J-47-
Office Phone: cell#. 6455 Fax # C?QQ ZzAD,.5 E-mail q
APPLICANT INFORMATION
Check any that apply: _ Change of ownership Change of use _Change of name New business
Business Name/Type: Fy_=;ror_yy r it--)
Previous Business on this site f
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: R aj c-kA r4-h I I<- Fx&-,— 41) bWNC_-,t:_-
-1 D VA i -SPI
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c�& Ll I 1-J3. nct aL-44 r-ivi n V -in Jar- -sew "cl, 7b ry-,m I 16D are,,
*This Clearance will only b I'd I the parcel for which it is approved. If you change, intensify or move the use to a new location, a new Zoning
' 0
d
Clearance will be required
I hereby certify that 1 OV.4 or ha e th e s permission rmission to use the space indicated on this application. I also certify that the information provided
t - sperm
is true and accurate to e best � f Jmyow d �. I have read the of approval, and I understand them, and that I will abide by them.
Z� I
Signature Printed Jarr-" g-
M
APP k6VAL INFO A ION
[%JApproved as propos d Approved with conditions Denied
I
[ ]l3ackflowpreventin 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:
A/A,
Building Official Date
Zoning Official 1-14, L A Date /off
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 7/l/2011 Page 2 of 3
Intake to complete the following: Reviewer to complete the following:
Y / `� Square footage of Use:
Is uson LI, HI or PDIP PP
, so
zonin g ? If ive a licant a Certified
g
Engineer's Report (CER) packet. Qrmitted / N
as:
Y/N
- -- - - -Will there be food preparation? -- - - - - - - -- -- - UnderSection: - -- - - - -- - - --
If so, give applicant a Health Department for j
Zoning review can not begin until we recei e approval from Health Supplementary regulations section:
Dept. FAX DATE
i
Circle the one that applies Parking formula:
Is parcel on private well or public ter?
- = - If private well, provide Health Dep rtment form. -- - - - - - - - - -- - - - -
Zoning review cannot begin until a receive approval from Health 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 ewer?
Y/N
Will you be putting up a ew sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
Will there be any n w construction or renovations?
If so, obtain the pr per Permit.
Permit #
1 d
Zoning to complete the following:
Inspector : Date:
Notes:
Violations:
Y/N
If so, List:
Proffers:
Y/N
If so, List:
Variance:
Y/N
If so, List:
SP's:
Y/N
If so, List:
Clearances:
SDP's
Revised '7/1/2011 Page 3 of 3
r.
707 Belvedere Dr.
Charlottesville, VA 22901
Phone: 434 - 973 -7946
Fax: 434- 973 -7761
April 20, 2012
- Ms-.-Sherri S:-- Rroetor Re1'r�juma�
Senior Permit Planner
Department of Community Development
401 McIntire Road
Charlottesville, Virginia 22902
Dear Ms. Proctor:
Enclosed please find the completed Application for Zoning Clearance regarding the Fairview 5K,
scheduled to be held on July 21, 2012, as well as a $35.00 check to cover the application fee..
Should you have any questions or I can provide you with any additional information, please do
not hesitate to contact me.
Jams F. Neale
Enjosure
c: Theresa Coppola (tjcc25 @yahoo.com)
JFN:aph
\11141726.3
RECEIVED.
APR 2 3 2012
COMMUNI`I)"
DEVELOPMENT