HomeMy WebLinkAboutCLE201200136 Legacy Document 2012-10-23Application for Zoning CIJ
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PLEASE REVIEW W ALI, 3 SHEETS
OFFICE USE ONLY
Check B Date:
Stiff:
PARCEL INFORMATION
Tax Map and Parcel: -VA (Q I Vj Existing Zoning.. J✓AP
ParcelOwner., fresis +-kyAtLi- -72oo W(scop5i t,,, Mu jl3 MsDA MD 20z(- �
PriecelAddress: 2025 BOND STREET City Charlottesville State VA Zip
(include suite 01. floor)
PIUWfARY CONTACT
Who should we call /write concerning tlilsi)l'o.jcct? JEFFREY TAYLOR, AIA
Address: 672 NORTH BROADWAY City WHITE PLAINS State, NEW YORK Zip 10603
office Phone: (214 cell pax ft 914 289 0022 E-,mall ... )2890011 ilitaylor@tayforarchitects.com
APPLICANT INIFOR_ IVIATION
langeofHarile X New business
Cheep any that apply: Change of owriel,.jilip Clialige,of use Cl,
Business Naineffype: TRADER JOE'S
Previous Business on this site —n/a (Trader Joe's is a first time tenant build-out)
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, iiiiinber of
vehicles, and any additional Information that you can provide.- SPECIALTY GROCERY STORE - RETAIL (no food
preparation on -site - all prepackaged goods)
21"5 SRI F1'-5 PP-A- r-*-4
*This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or nova the use to a new location, a now Zoning
Clettrauco 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 A (AAA Printed JEFFREY TAYLOR, AIA
--U-
APPROVAL INFORMATION
Approved as proposed Approved with conditions Denied
Bickflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, xI 17.
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.
No I es:
Building Official Date
Zoning Official Date
Other Official Date
UOU11ty 01 AWentarieuepartinent or %-oiuinujnnyuevejupjjiUtjL
401 Alclutire, Road Charlottesville, VA 22902 Voice: (434) 796-5832 Fax: (434) 972 -4126
4 Revised 7/1/2011 Page 2 of 3
Intake to complete tite followhig:
Reviewer to complete the following,
Y / (1
Square footage of Use: ^z
Is u m LI, HI or PDIP coning? Ifso, give applicant a Certified
.Engineer's Report (CER) packet.
Permitted as;J
Y /(�1�Y
— ......
�Vil sere be food preparation?
Under Section: �• C o I )
If so, give applicant a Health Department form.
Zoning review cannot begin until we receive approval from Health
Supplementary regulations section;
Dept. FAX DATE i
Circle the one that applies
Parking formula:
Is parcel on private well or p fir ?
Ifprivate well,1) rovlde Re, Ith epartment form.
Zoning review can not begin until we receive approval from Health
Required spaces:
Dept. 1±AX DATE
Y/N
Circle the one that app fig
Items to be verified in the field:
Is parcel on scptle or lies r?
Y/N
Will you be puffing up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit# �6f9� 16 51
Gi
rr__.:...,. r.,. J.U. 0.,11....4.....
Inspector
Notes:
Date:
Vtolattons:
Y/
Ifso, gist:
roffers:
/N
so, List:
— ......
Mari: ce:
Y/
Ifso :sf:
SP's:
Y/N
If so, List:
Clearances:
SDP's
_
/i- 2—
Revised 7/112011 Page 3 of 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.
I certify that notice of the application, AQ?e Ma(--L*, CPOuTq - IMEe'63f,5 ANT'
[County application name and number]
was provided to �� � S 4 AU the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number 'M (0 S W ' 3 ' 2A t 'E 11 by delivering a copy of the application in the
manner identified below:
Hand delivering 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
Date
a
Mailing a copy of the application to CHRIS NAME OF EDANS & AVANT
[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]
Date
to the following address:
'1206 Wi5com5kN AVe, A9fe5DA YD
[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].
SigWqture of Applicant
Print Applicant Name
JUN 1-� 2012
Date