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Home My WebLink AboutCLE201400009 Legacy Document 2014-01-30le) M-4) I Application for Zoning Clearance os_ PLEASE REVIEW ALL 3 SLEETS OFFICE USE ONLY Cheek # 1 ZI 14 � 4 Receipt # Z l Staff: PARCEL INFORMAT N ?: Tax Map and Parcel: 0- _a - 300 Existing Zoning U Parcel Owner: 4p_, lrk T id yd r Parcel Address: )JAIQ TCity C W 10A&V114 State Via Zip (include suite or floor) PRIMARY CONTACT Who should we call /write concerning this project? 7-Eleven inc Address :1722 Routh Street, Suite 1000 ---City Dallas _ State TX Zip 75221 Office Phone: ( 804) 769 -3981 Cell # N/A Fax # N/A E -mail caryl.put-cell@amelialicensing.co APPLICANT INFORMATION _ Check any that apply: X Change of ownership Change of use Change of name New business Business Name /Type: 7- Eleven 11136J- retail convenience_ _ Previous Business on this site 7- Eleven 1.11368- retail convey tieince 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 rovide: _ P.I71 �1'flttS rla �;��►' r� SDUC�s a aR& 00 r rptnol ronVpnipricP yP.PS per 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 lmowledge. I have read the conditions of approval; and 1 understand them, and that I will abide by them. Signature C ~ �`l� �7 — printed Caryl Purcell APPROVAL INFORMATION Approved as proposed [ ] Approved with conditions [ ] Denied [ ] Backflow prevention device and /or current test data needed for this site. Contact ACSA, 977 -411, 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 - -�-' -� e — Dater Zoning Official Date Other Official -- _ _ - -- bate • County of Albemarle Department of community veve!opment 461 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 Y/N Is use in LI, I-II 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 of lublic 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 or ub1'r Y /(0 Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Y /qWill ere be any new construction or renovations? If so, obtain the proper Permit. Permit # ..1 4. e•h 4'-11 anon•. Revie,%,er to complete the following: Square footage of Use: T ON n l Permitted as:1; Under Section: Supplementary regulations section: Parking formula:��s Ci Required spaces: Y/ items to be verified in the field: Inspector: Date: Dotes: Violations: If so, List: Pro, °rs: If so, ist; Variance: f sost: SPPust: Y If Clearances: SDPI's Revised 7/1/2011 Page 3 of 3 CERTIFICATION THAT NOTICE OF THE APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER Tlais 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, lwf irlo4 i1 A( 2m,/74 e1E6(6Ct yie (- [County application nameabd number] was provided to 41EA r U- -.a V0 ) " the owner of record of Tax Map [name(s of the record owners of the parcel] and Parcel Number �6e —d- 36 y __ _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] m Date K F,nry U&V0) -, OWA&r C/O f Mailing a copy of the application to VC n o &'r l`I rldt Doss q JrYle- [Name of the record owner if the record o er 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 to the following address: Date l bq A Swiwkc )rW/ , aarlo tfa01L-c, V& aag01 [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]. C (Y� &Mw Signature &Applicant CQ.r I 1. f�c�r'�ll Print Applicant Name /-/&- aoiy Date AMELIA LICENSING, ITC 1619 Woodbury Road ® Walkerton ® Virginia 23177 804 - 769 -3981 office /fax January 17, 2014 County of Albemarle Dept of Community Development 401 McIntire Road Charlottesville, VA 22902 -4579 To Whom It May Concern, The 7- Eleven Store located at 1849 Seminole Trail will become corporate store "7- Eleven 11136J" on January 24, 2014. I have attached a completed zoning application, a floor plan, my power of attorney, and a check for $50.00. I contacted the Health Department on January 9t' and was informed they do not cover 7 -Elevn stores. If any additional information is required, please contact me at 804 - 769 -3981 or ca.i 1 purcell<caamelialicensing. coin. We would like to pick up the approved zoning clearance if at all possible. Thank you for your assistance, Coy 4ed; Caryl Purcell Licensing Specialist Amelia Licensing LLC 4> 3 $I ®I f ' _' :! 7- ELEVEN STORE # 11136 o 1849 SEMINOLE TRAIL ° �i wi °,� CHARLOTTESVILLE, VA 22901-1129 SIORAGC1510Ei1MCEJ51RttNVAO LJSIYIXRIACC SlElr V V \I 310RAGE SNEIE I 1 K D s�N L _ — x00 V NI WO V Ni#7dUS 3DVtlD1$ ,C 7 -0 N0P m� Y ~� R IIUD rosr uix g� c ®® °PCAS[ R EEE OEC � Orn � ¢ aIona o -3NCq -3-Cq BEVERAGE BAR g � o 0 0 0 COFFEE ISLAND A' Cl 3• 'A' Cl a• [IG ® n r 1 �n ®'8 ri � N off.. POS BOWS POs Oz IN � CNi C P RACH FACN Z I• I N_ I OI n 8 G fi _ dtlJ Dx3 g a 5 QI £ xN �� k3� SC y 3N NhM tl3100 I O R�8 LIGARCiiCi y A�$ 1 L dVJ DN3 dV] ON] � 3' StDRAGE SHFIS O 8A END GP $ � N33tl]S ON3 tl3510lla 3tl3W 3]i d3Z33tlf D4K dW3l x,01 �� E dYJ ON3 ddJ ON3 dq 0N] dtl] 0N3 �(�mp�� $I ®I f ' _' :! 7- ELEVEN STORE # 11136 o 1849 SEMINOLE TRAIL ° �i wi °,� CHARLOTTESVILLE, VA 22901-1129 AMELIA LICENSING, LLC 1619 Woodbury Road e Walkerton e Virginia 23177 804-769-3981 office/fax January 9, 2014 RE: Power of Attorney for 7-Eleven Inc. To Whom It May Concern: 1, Jennifer Bridges, Vice President of 7- Eleven Inc., hereby authorize Caryl Purcell, Neal Seay, and/or Ron Maupin to act on my behalf to apply for, certify, obtain, or perform other processes to acquire all required licenses for my business, 7-Eleven 1.1136J located at 1849 Seminole Trail, Charlottesville, VA 22901-1129.. This authorization is effective as of the date of this letter and will be void after June 30, 2015. 7-Eleven Inc By: wame: J ifer ridges Title: vice President State of Texas City of Dallas Subscribed and sworn to (or affirmed) before me this day of 20-Lb by Jennifer Bridges, personally known to me or proved to me in the bases of satisfactory evidence to be the person who appeared before me. Sigifatilre of Notary My commission expires on f.> Registration Number Stamp k, OY C, OeGreOentd it Nrl' ry Public, State of Texas MY Comm, Expires 0311312011