HomeMy WebLinkAboutCLE201300072 Legacy Document 2013-05-06Application for Zoning Clearance
OFFICE US N Y
# I
PLEASE REVIEW ALL 3 SHEETS
Check Date:
/
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: 077E1- 00- 00 -001CO Existing Zoning_ COMMERCIAL /LI
Parcel Owner: AVON STREET BUSINESS CENTER
Parcel Address: 1575 AVON STREET EXT,STE104City CHA.RLOTTESVILL $ tate VA Zip22902
(include suite or floor)
PRIMARY CONTACT .TOE SANFORD
Who should we call /write concerning this project?
Address: 1575 AVON STREET EXT, STE 103 City CHARLOTTESVILL§tate VA Zip 22902
Office Phone: (_) Cell #434 - 806- 5979Fax# E -mail info@athelitefactory.cc
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name x New business
Business Name /Type: THE ATHELITE FACTORY
Previous Business on this site PIEDMONT ELECTRONICS
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: INDOOR FOOTBALL TRAINING
*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 y knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature !•••w Printed
PPPP lV FORMATION
A p ed as proposed [ ]Approved with conditions [ ]Denied
[ ] ckflow 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 r Date a
Zoning Official Pr e Date
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
Intake to complete the following:
), I,& W MWIM usc)
Is use in (LI Ar PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y 16
Will 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 applies
Is parcel on private well oi6 ublic water?
If private well, provide Health 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 of public sewer?
Y) / N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign perm.
Permit# hA- Pc b� OT q
1 y
Y /O A u �Vw
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
{
Reviewer to complete the followin
Square footage of Use:'v
fitted as:
Under Section:
Supplementary regulations section:
Parking formula: ' / I -:a- J n Pa-
Required spaces:
Y/N
Violations:
Y/N
If so, List:
Proffers:
Y/N
If so, List:
Variance:
Y/N �@
If so, List: I`l�i
[ a j
SP's:
Y/N
If so, List:
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, THE ATHELITE FACTORY
[County application name and number]
was provided to AVON STREET BUSINESS CENTER the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number 077E1- 00- 00 -OO1C0 by delivering a copy of the application in the
manner identified below:
X Hand delivering a copy of the application to STEPHANIE HOUSDAN
[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 3/1/13
Date
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
Date
to the following address:
[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].
�Signa u' of Appl'
Print Applicant Name
D e
CC)CN -\ ` 1
su CL� X013 �l�
Door,
Iaz.,
zG4a;�5 cis
W
I
1
�yr7G�✓