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Home My WebLink AboutCLE201300014 Legacy Document 2013-03-27i � 1 Application for Zoni+ng Clearance `9 �7hc;IN1P` OFFICE USE ELY PLEASE REVIEW ALL 3 SHEETS Check # ` Receipt # Staff: PARCEL INFORMATION �aGS( a Tax Map Parcel: M Zoning (so and _j�' o �� r �L�Existing Parcel Owner: -o -h �1 i�C '�_ C Parcel Address: �� Reci, S, crPc 1' tV `City State Zip 2.2 �/nl� (inc ucll eessuit or floor) PRIMARY CONTACT Who should we call. /write concerning this project? C�A p ►w� > 1Jl Y� 6- Address : 7 �� /� City C— V l I f State Zip 2 11_L Office Phone: (11�r�. J �(7 i "`cell # Fax # E -mail (A i L APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business Business Name /Type: 2s +Si `I c�'k�"� r)0, ( 6 C� �,h A I' ( I b r1ny �1-r SOl - Previous Business on this site 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: ) a C u ) �r M *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 to the best of my knowledge. I have read the conditions of approva'l,f and I understand them, and that I will abide by them. Signature �o� Printed VV\ l APPROVAL INFORMATION [ pApproved as proposed [ ] Approved with conditions [ ] Denied [ ] 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 site complies with the site plan as of this date. Notes: Building Official Date i 13 AaA Date Zoning Official 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 7/1/2011 Page 2 of 3 INESTY INTERNATIONAUCTC Q Rt` OAU�IQfC'AOItufAG. Wentine Couples Race ,00 am, Saturday, February 9, 2013 �gister here OR online at vw. charlottesvilletrackclub .org/couples5k.html This 5- kilometer course will begin and end at the pro shop of the Old Trail golf course (see over for map), Race numbers and day -of -race entries will be available at the pro shop on the morning of the race. Enter the race with a partner or have us find one for you if you prefer. You do not have to run with your partner, but your times will be added together to determine winners in each of six race categories (see race entry form, below). • Entry fees (each runner): CTC members- $18.00 Non -CTC runners- $20.00 All entries on the day of the race- $25.00 • All entrants will receive a special 100% cotton long- sleeve T- shirt. To receive your T -shirt at the race, registration must be received by 5:00 pm, Friday, February 1, 2013. • All inquiries about the race and registration should be directed to cvilleai @amnestycharlottesville.org. Changes to team partnerships will not be allowed after 6:00 pm on February 8, 2013. • Race postponement due to severe weather will be posted at web site amnestycharlottesville.org. Race and location maps are also posted there. • Make checks out to "Amnesty International." Mail with your completed entry to: Al Couples Race, P.O. Box 981, Charlottesville, VA 22902 �< ................................................................................................................................................................................................................................................................... ............................... Al Valentine Couples' Race ENTRY FORM Partner 1: (Last) ( MI) (First) Name: ❑0 0 ❑❑❑❑ ❑ ❑❑ [1000 ❑ ❑0 ❑ ❑ ❑ ❑ ❑❑ [100[1 Address: 0❑0000 [1000000 ❑10 ❑ 00 ❑0000 11 ❑❑0000 111111110110 11011000 ❑ ❑ ❑❑ Phone: (❑ ❑ ❑) 000-00011 Cell Phone: (1111 0) 0110-11000 Email: 0000 0000111111111111000 000000 11 T -shirt size (check one): ❑ XL ❑ L ❑ M ❑ S Track Club Membership: ❑ CTC member ❑ Nonmember Partner 2: (Last) Name: ❑ ❑000 ❑0❑ ❑ ❑ ❑ ❑ ❑❑ Age: ❑ ❑yrs, Gender: ❑ ( MI) (First) ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ Address: ❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑ ❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑ Phone: (❑❑❑) ❑❑❑-❑❑❑❑ Cell Phone: (0❑❑) 1111❑ -❑❑❑❑ Email: 1111❑❑❑❑❑❑❑❑ ❑000 ❑00❑❑❑❑ ❑❑❑ T -shirt size (check one): ❑ XL ❑ L ❑ M ❑ S Track Club Membership: ❑ CTC member 0 Nonmember Age: ❑ ❑yrs. Gender: ❑ Race Category (check one) ❑ Male -Male ❑ Female - Female ❑ Male - Female ❑ Husband - Wife ❑ Parent- Child ❑ Siblings Waiver: Must be signed by both partners (parent or guardian if under 18). No baby joggers, strollers or pets allowed on the course. Running a road race is a potentially hazardous activity. Runners should not enter and run unless they are medically able and properly trained. I agree to abide by any decision of a race official concerning my ability to safely complete the run. I assume all risks associated with running in this event, including but not limited to falls, contact with other participants, the effects of the weather (including cold and precipitation), traffic and the conditions of the road, all such risks being known and appreciated by me. Having read this waiver and knowing these fact and in consideration of your having accepted my entry, I, for myself, and anyone entitled to act on my behalf, waive and release the Charlottesville Track Club, Amnesty International, The Old Trail, the County of Albemarle and all sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in this event. This is a road race conducted under the rules of the USATF. Absolutely no baby joggers, strollers, headphones, animals on leash, skateboards, skates, roller blades or bicycles will be allowed on the course. Participants agree to be bound by the rules established by the Charlottesville Track Club and the organizers of the race. I understand that if the race is postponed or cancelled by circumstances beyond the control of the race organizers, my entry fee will not be refunded. Signature, Partner 1: Date: t Signature, Partner 2: Date: