HomeMy WebLinkAboutCLE201200241 Legacy Document 2012-11-28Application for Zoning Clearance"
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PLEASE REVIEW ALL 3 SHEETS
Check # Date;
Staff:
Receipt #
PARCEL INFORMATION r-'P 5 C
Tax Map and Parcel: 4 �' / -" / 3 Existing Zoning
Parcel Owner: .lPJ" ,,tr � dl/ i €J" C%/0
Pit rcel Address: � d ZiZ-P � `
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project?
Address: ,trey 9�3 City state p ZZZ zi
Office Phone: Cell # 20k � Fax # E -mail V. 5 +Elaf+`AKK
APPLICANT INFORMATION
Check any that apply; Change of ownership Change off use Change of name New business
-S • G. � W •i e Y' "L5 ( /
Business Narnefrype:
Previous Business on this site
Describe the proposed business including use, number of employees, number of shiftst available parldng 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 tine use to a new location, a new Zoning
Clearance wil l 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
the of approval, and I understand them, and that I will abide by them,
is true and accurate to the best of my knowledge..I have read conditions
Signature Printed A5�{�'� r4s-m +/-
APPROVAL INFORMATION
Approved as proposed [ l Approved with conditions [ 1 Denied
[ ) Back-flow prevention device and/or current test data needed for this site. Contact ACSA, 977 - 451:1, x117,
[ J No physical site inspection has been done for this clearance. 'Therefore, it is not determination of compliance with the existing
site plan.
[ ] This site complies with the site plan as of this date.
Notes:
Building Official Date i �{ Z
Z,Dj 4�
Zonin g Official �( Date
Date
Other Official.?
lUOUnty Ul AiDemarie mepaxtums- v, Uv ...... .....1
441 McIntire Road Charlottesville, VA 22902 Voice: (434) 296- 5832 Fax; (434) 972 -4126
Revised 7/1 /2011 Page 2 of
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Intake to complete the following: Reviewer to complete the following:
Y / 0 1 Square footage of Use:
'f d
Is use n LI, m or PDIP zoning. ,
If so, give applicant a Certi ie
Proffers:
Y / ,
If s , L' t:
Engineer's Report (CER) packet.
/ N ) /
lermitted
((�l
Y
as: ;16A/lq / S
Will there be food preparation?
Under Section: 04, _ A6 .; 9
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from Health
Supplementary regulations section:
Dept. FAX DATE
Circle the one that applies
Parking formula:
Is parcel on private well or_ blic wa er?
If private well, provide He ]th De ment form.
Clearances:
Zoning review can not begin until we receive approval from Health
Required spaces:
Dept. FAX DATE
Y/N
Circle the one that ap ies
Items to be verified in the field:
Is parcel on septic or pub 'c sewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Inspector : Date:
Permit #
Y / N
Notes:
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
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Violations:
6)/ N
If so, List:
Proffers:
Y / ,
If s , L' t:
Varian e:
Y /
If so, List:
SP's.
Y /
Ifs ist:
Clearances:
SDP's
Revised 7/1/2011 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,
[County application name and number]
5110 rPC— CJ a tti (.-,o —
was provided to ; l �
.' i the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number 00 -� �—�,o —� S�C� 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
Mailing a copy of the application to ��� �a'� `�'�' ✓� ��"��
[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
I1/ 7' S / 3
[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.)A-4e-U.
Signat p o Applicant
y0s C- Pj--F
Print Applicant Name
Date
Federal Realty
INVESTMENT TRUST "
FOUNDATIONS OF OPPORTUNITY
It 17 Emmet Street
Charlottesville, VA 22903
PH: 434.977.0100
F\: 434.296.3563
October 31, 2012
Yoseph Asmellash
JB Enterprise
1121 Arlington Boulevard
#N243
Arlington, VA 22209
Re: Shopper's World
Dear Mr. Asmellash:
This letter is to confirm that Federal Realty Investment Trust has negotiated terms with you at Shopper's
World for the term of November 20, 2012 through December 26, 2012 for the retail sale of Christmas
trees, greenery and wreaths.
The sole purpose of this letter is to allow you to obtain the necessary permits for the space, as the
License Agreement is still in the process of being fully executed. Please let me know if you have any
questions or need anything further.
Sincerely,
Tina D. Morgan
Specialty Leasing Administrator
cc: File
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