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HomeMy WebLinkAboutCLE201300291 Legacy Document 2013-12-13� I�t�lti1 d IA,�P, Q,�fb7�1 -la q2J l2u61ius51AM 6-1 f"6 -bb -pin Application for Zoning Clearancer;�y;``� CLE # 2b 1 ?)_ Z Q ( �/ti(i1N�P PLEASE REVIEW ALL 3 SHEETS OFFICE USF,� Q}\'LY Check # L`(p Date: 12 Receipt # Staff: PARCEL INFORMATION , �1 —pC1`00-jC�cQ Existin Zonin f W k4 3Yyrae,/ -Ci ' Tax Map and Parcel: �Clkl�}(���r g g Parcel Owner: 61V0,(Yk A(47A=s..) - �"�� , ) Parcel Address:���s 1 Skm e Ouzo CZ 4) AD City(��(U9�SYl�� State V� zip 2290 (include suite or floor) PRIMARY CONTACT {�� Who should we call /write concerning this project? tA2\e3aLt Address: XfiCk(-1 Qi(2Q,)C_ `�1 ���Z City �?)t'Kv`(• \c`�� PbMI \QState Zip G� Office Phone: (_� Cell # #N-4 1 t (_,) Fax # E -mail ([m661kS01eyG, 2 0 %4vne APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business Business Name /Type: Previous Business on this site (ie_De _ C�YIS�fIJC�1� ^� Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of L vehicles, and any additional information that you can provide: 04 hG r "I )+rne.cs *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 mowuL�, II ,h(ox Printed M_60&4 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: � r Building Official _ Date P I� f Zoning Official Date Z Z- 7/r7��� 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 ?-&"S'. C1n Intake to complete the following: Y /0 Is use in LI, IT or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y / Will 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 r public water? If private well, provide Hea t epartment form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that applies Is parcel on septic pu lic sewer? Y/N Will you be putti�up a new sign of any kind? If so, obtain proper Sign permit. Permit # A YY N `Will there be any new construction or renovations? If so, obtain he ro e • e it. Permit # I , Y 4.... ..1n4.. 41,0 V^11-7—M- Reviewer to complete the following: Square footage of Use: 1/yOo N n �17) � Lifted as: n/J! z'r e-41 y Under Section: ZLI • Z' Supplementary regulations section: Parking formula: � Required spaces: 2: Y/ U Items to be verified in the field: Inspector: Notes: Date: U11111r, LV ►.V111 1GLG L11L. 1U.LV I... Violations: &N If so, List: Proffers: t)/N If so, List: Variance: Y/ `� If so, List: P's: "/N If so, List: Clearances: SDP's Revised 7/1/2011 Page 3 of 3 a 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 [name(s) of the record owners of the parcel] the owner of record of Tax Map and Parcel Number ny ` Q0 <XU"00-- x©100 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 [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] rn 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 pplicant Print Applica Name va 01\c? Date REST R❑OM 0 UTILITY / STORAGE: T -2 0 FREE WEIGHTS j T -1 /VCT -1 RF -1 I j i 882 S.F. REST R❑ ❑M REST R001H T-2 i i i i i i i i i r r r r TRAINER CA -1 MULTI- PURPOSE ROOM VP -i - - - -- i 582 S.F, i I I 1 TANNING T -1 /VCT -1 � I } STRENGTH TRAINING LL7 CA-1 MEMBER LUBBX T -1 /VCT -1 I /I i � GKAr'1�YC wAl' I' I I I i �� I r41Rnr ❑1 �TTES���L��E, vo. OFFICE 4,400 S.F. CA -1 \\j ETAIL WALL EARTH COLOR SCHEME l INSPIRATION WALL �l I GUEST LOBBY CARDI❑ T -1 /VCT -1 II I I r i WASSENAAR DESIGN GROUP A PROFESSIONAL CORPORATION 107Velwnnoo, Ch.ftU— I0o,Vn22911 Ttnphono(474) 8774882 5804HowoN I1Io TmPIM,AR4n,VA22S20 T Iophono1Fmc(640)941-3587