HomeMy WebLinkAboutCLE201300084 Legacy Document 2014-01-03r
Application for Clearance
0
��Zoning
OFFICE U EQNLY ✓ ��
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PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Receipt # b Staff:
PARCEL INFORMATION
Tax Map and Parcel: (� i °( UG- bb - -y60 Existing Zoning 6�''
�,,Jz. -C s'r�
Parcel Owner:
Parcel Address: �t �`' ''� I� � City M OA aJIC4-t State /t Zi PIZ 0 If s
(include suite or floor)
PRIMARY CONTACT r (� CL Cf CA46
Who should we call /write concerning this project?
C 2z�s�y
FL � � City `y �� State l/� '- Zi
Address :
t 3 1 L t) 600' 0�- >�I � U � V►'TVP1 ,-J,0 J- C� lea
Office Phone: U Cell # Fax # E -mail G
APPLICANT INFORMATION
Check any that apply: Change of ownership of use Change name `New business
�Change Lof
/�
�f `� "� ✓r fp t✓ till 6ell- Pi y
Business Name /Type: ���-� ° -�
Previous Business on this siteV1
Describe the proposed business including use, number of employees, numAer of shifts, available parking spaces, number of
vehicles, and any additional information that you can provide: y i e '� n
c_
*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 r`��i7 G kA C
/
APPROVA ORMATION
[ 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 c Date
Zoning Official Date
Other Official Date -Z Z-1-613
County of Albemarle Department of Community Deveiopment
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 7/1/2011 Page 2 of 3
i
Intake to complete the following:
Y
Is m LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Yf N
ill there be food preparation?
If so, give applicant a Health Department form.
Zoning review cannot be in un 'I we receive approval from Health
Dept. ' F TE r
Circle the oife app Tie
Is parcel o private well -r public water?
If private Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the a plies
Is parcel o septic public sewer?
I',Y N
ill you be putting up a new sign of any kind? If so, obtain proper
Sign permit
Permit # U
N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit # � A-
7 rimnlr 1'n orimnIP'fP fl7P fnllnwln¢'
Reviewer to complete the following:
Square footage of Use:
;I / N
Permitted as: r' ; A U r✓ '����
Under Section: G 2-1
Supplementary regulations section:
Parking formula:
Required spaces: 37
Y/(9
Items to be verified in the field:
Inspector
Notes:
Date:
Viof ations:
Y/
If so, ist:
Proffers:
Y/1
If so, List:
Variance:
Y /(10 Q
If so, List:
SP's:
a/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, Zo f 2 Z 3 ,> C, n- [--
[County application name and number]
was provided to
W?f "ptr-1 Mme, hscz, the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number 1 U6- aG — 60- 065 -Oc'
7::liverina d below:
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
2-11 AL
Date
by delivering a copy of the application in the
w(f r14 e�l qyiio b sc
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
I`
• A
k
0
In Cooperation with file
State Departmerlt of Health
Phone (434) 972 -6219
Pax (434) 972 -4310
�+ OiH1
COMMONWEALTH of VIRGINIA
Thom(is Jefferson Health .District ALOGMARLU • CHARLOTTESVILLE ,
FLUVANNA COUNTY (PALAIYITA) '
1138 Rose Hill Drive OnUENE COUNTY IS rANARDSVII.I.E)
LOUISA COUNTY(LOUISA) ;
R 0. Box 7546 NELSON COUNTY (LOVINGSTON) '
Charlottesville, Virginia 229os
'Decernber 19, 2Q11.
Michael McCarthy i
P.O. Box 336 I}
North Garden, VA 22959 j
RS. Plan review status —.n I . Rio's Rumble:Pie, 4916 Plank kd, North Garden, VA 22959
Dear Mr. McCal•thy,
Thank you for your detailed play submittal and for answering My questions Concerning the project. The
plans have been .reviewed and approved byihis department.
r
It is .important that any deviations front the approved plans be first reported to this department for review.
Furthermore, all opening inspection will be required upon completion of the facility, please call this
office at least one week ill advance to schedule au appointment,
Should you have any questions, please do not hesitate to Contact me directly.
Sincerely, '
i
I
. -K, Eric Stutz, IWI-1, REHS i
Eltvir01111 ntal Health Specialist, SI••
Cc; Eric Myers, ET7 Supervisor
File