HomeMy WebLinkAboutCLE201300151 Legacy Document 2013-09-04Application for Zoning Clearance`
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OFFICE -7-1-2 Y +�
PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Staff:
Receipt #
PARCEL INFORMATION
Tax Map and Parcel: Existing Zoning
Parcel Owner: �or iy6k 60v,- t)" ct
Parcel Address: 3CCq &rkMr V4^ . City(fAL/ U SLI11le State ✓A Zipc�!a90
(include suite or floor)
PRIMARY CONTACT ^� %
Who should we call/write concerning this project?
Address City /? � G' (rz State Zip 0
Office Phone: (Zo-) 7 Z 7 ~5 ell # 1544k - Fax # E -mail S/Pl � eCG ► sy/
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: .r, 'SA
Previous Business on this site
Describe the proposed business including use, number of employees, number of s ifts avaJlable parking spaces, number of
vehicles, and any additional information that you can provide: C 'e_n A e� LA�o 7 Gxr� 4;5 �c Q �
*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 approval, and I understand them, and that I will abide by them.
Signature �'� Printed #1AVb�il�
APPROVAL INFORMATION
[ ] 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 Date y�ZY�ZoJ3
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
TY
Intake to complete the following:
Y/N
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /1V
Wi ere 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 or 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 appli
Is parcel on septic o public er?
V�' � N
you be putting 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 #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use:
() /N
Permitted as: (. G1 Lkf 6
Under Section: 2 �/. I-.
Supplementary regulations section:
Parking formula: /
Required spaces: / �f
Y/ (Iqp
ItemM be verified in the field:
Inspector : Date:
Notes:
Violations:
Y /
If S&,-fist:
Proffe :
Y / )
If so, List:
Variance:
Y/
If so—,List:
SP's:
Y /lel
If so, 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,
was provided to
[County application name and number]
[name(s) of the record owners of the parcel]
the owner of record of Tax Map
and Parcel Number by delivering a copy of the application in the
manner identified below:
c2L 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
[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].
Signature of Applicant
Print Applicant Name
Date
Jay Schlothauer
From: Tony Schiavone [tony @cornerstonecommunity.ty]
Sent: Monday, July 15, 2013 11:58 AM
To: Jay Schlothauer
Subject: Re: 3004 Berkmar Drive
Jay,
On our busiest Sunday we have 80 people.
Tony
Sent from my iPhone
On Jul 15, 2013, at 11:31 AM, Jay Schlothauer <JSCH LOTH @aIbemarle.org> wrote:
Tony,
I am trying to complete my portion of the review for the zoning clearance application for Cornerstone
Community Church at 3004 Berkmar Drive and I have one quick question. On your busiest worship
occasion, how many folks are present at one time?
Thanks,
Jay Schlothauer
Director of Inspections / Building Official
Albemarle County Department of Community Development
401 McIntire Road
Charlottesville, VA 22902
telephone: (434) 296 -5832, ext. 3228
fax: (434) 972 -4126
ischloth ,albemarle.org