HomeMy WebLinkAboutCLE201200255 Legacy Document 2013-08-08• • •
Application for Zoning Clearance
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CLE # 2,012 - Z 65
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONL
Check # 216 Date: 12. `q '?—
Staff: T-f-
Receipt #
PARCEL INFORMATION ,{
Tax Map and Parcel: Qi6i Wb — 6-3 `C f) — 6 ( C� 1 1 0 Existi g Zoning �-
Parcel Owner:'TVl 'f-- d !�;-
Parcel Address:-'-L 0 a 1E) �1NS:> ST" CiteiAQ�2tDvi d 11.LC State - Ziprztzb 7 J�
(includes ite or floor)
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PRIMARY CONTACT ,
Who should we call /write concerning this project.
Address : P o , City t&IN =14i State Zipz
Office Phone: ell APD —.(G U Fax # E- mailer
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: ZI S-->G
Previous Business on this site �,l Ew t
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: 171ITIe 4I1 S Pi t iz 4, lr 1^4 EE S- t,
0 V.J l; S, 1A 1_i a i
*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 accurat a best of m t�waedge-Dread the conditions of approval, and I understand them, and that I will abide by them.
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Signature .G' ----� Printed �6 � 0 T
APPROVAL INFORMATION
'Ix] Approved 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
Zoning Official ,� �l/r Date
Other Official Date
County of Albemarle Department of t-Ori mnnity lieveivp►ueuL
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 7/1/2011 Page 2 of 3
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Intake to complete the following:
Reviewer to complete the following:
Y /0 Square footage of Use: lys 000
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet. �J/ N
Permitted as: j1
Y
Will there be food preparation? Under Section: ( (Q _ GL - A 14iJ •
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
Is parcel on private well o public 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 a lies
Is parcel on septic o public sewer?
9/ N
Will you be putting up a new sign of any kind?
Sign permit.
Permit #
If so, obtain proper
Parking formula: 1 p ( 01) C)
Required spaces: to
Y/N
Items to be verified in the field:
Inspector
/ N Notes:
ill there be any new construction or renovations?
If so, obtain the ro er P rmit.
Permit # , a a -fll-
B�via - a3� -F�-P �e�►
7nninrt to ommnlph- 1'11P fnllnwinu!
F -Z; it✓tt-o L613-21—
Date:
Vioy ions:
Y (
If so, st:
ffers:
Y N
If so, List:
Nk
0-+
11
6
IX
..
N
- (3
Var ice:
Y T
If so, List:
SP's:
Y/N
If so, List:
Clearances:
SDP's
O ,
4
Revised 7/1/2011 Page 3 of 3
t't
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]
was provided to �� SI1��S Al �`ryty Lrr 1 EU7-' the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number(O(o 1 63 00 °- U 1),kU 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
+V Mailing a copy of the application to F— ®-&: l S � A 1 Y (4u E- '�7 hSF-
[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 1-z,S�1Z
Date
E Z>qfws I 170
to the following address:
sv
[address; written notice mailed to the owner at the last knownfaddress of the owner as shown on
the current real estate tax assessment books or current real estate tax assessment records satisfies
this requirement].
Signature of Applicant I
Print Applicant •N/�ame
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u z r G, 9 pp p 'V
Date
4, M C-,)
2D .Ea4-
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^ LeiperLz
C O N S T R U C T I O N
PO BOX 266 • MIDLOTHIAN, VA 23113
804.379.0048 • F: 804.379.8090 • WWW.LEIPERTZ.COM
County of Albemarle
Dept.. of Community Development
401 McIntire Road
Charlottesville, VA. 22902
LETTER OF TRANSMITTAL
DATE 12.5.12 JOB# 12-018
ATTENTION Todd Shifflett
RE: Blue Ridge Mountain Sports
The Shops at Stonefield
VIA: U.S. Mail ❑ UPS ❑ Fed -Ex
❑ Courier ❑ Picked Up ❑ Hand Delivered
❑ Other:
❑ Shop Drawings ❑ Specifications ❑ Plans ❑ Samples ❑ Subcontract Agreement
❑ Submittals ❑ Change Order ❑ Other:
COPIES I DATE I NO. I DESCRIPTION
1 Application for Zoning Clearance, Dated 12.5.12
1 $50.00 Check for processing fee
THESE ARE TRANSMITTED as checked below:
QFor Approval ❑ Approved as Submitted ❑ Resubmit _
❑ For Your Use ❑ Approved as Noted ❑ Submit _
❑ As Requested ❑ Returned For Corrections ❑ Return _
❑ For Reviews ❑ Other:
and Comment
❑ FOR BIDS DUE
REMARKS:
Todd:
Should you have any questions or require any additional information please let me know.
Thank you for your assistance.
Copies for Approval
Copies for Distribution
Corrected Prints
mEdens /File ® Bob Leipertz
❑ PRINTS RETURNED
AFTER LOAN TO US