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HomeMy WebLinkAboutCLE201400063 Legacy Document 2014-04-28Application i ®r ZoninxClearance �,�,, �'� 1, �� CLE # o ''!1 . A '., OF'F'ICE USE O • LV Un PLEASE REVIEW ALL 3 SHEETS Check # Date: Receipt # Ure, Staff: PARCEL INFORMATION pig �-Z Tax Map and Parcel: �� Existing Zoning ©j � �(�U���r p��Gl>� Parcel Owner: �V �—��(- Pa reel Address: Jit/ if )�{��1 �(f� tl f� LLU�� ��City �ii7R� �'Ti t�z t Mate th " Zip 2�g� — r(include suite or floor) PRIMARY CONTACT � �/✓�.'/ Sceeyr--:�'� Who should we call /write concerning this project? { l.�Q) Address • 2y(o e ,fi City Zip2'Z.�/'% Office Phone: CLN) 2 -;;Ic- d;Sc `71Cell # (f%' 7 /'- J7f 7 Fax # E -mail Xc/ nc? u= 'Sn�yp� %r�•�15.«• APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business F y Business Name /Type: C e � 1�U Previous Business on this site l Describe the proposed business including use, number of employees, number of shifts, . yaiiatole asking spaces, number of vehicles, and any additional information that you can provide: 0 *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 owq 's permission to use the space indicated on this application. I also certify that the information provided is true and, accurate to est m (a w_ conditions of approval, and I understand them, and that I will abide by them. Signature Printed APP AL INFORMATION [ pproved as proposed [ ] Approved with conditions [ ] Denied [ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977- 4511, x11.7. [ ] 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 late `t Zoning Official Date 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 /l /201'1.Page 2 of 3 W Intake to complete the following: Y/N Is use in LI, M or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y/N Will there 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 applies Is parcel on septic or public sewer? Y/N Will you be putting up a new sign of any kind? Sign permit. Permit # If so, obtain proper Y/N Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # Zoning to comviete the followinLY: Reviewer to complete the following: Square footage of Use: Y/N Permitted as: Under Section: Supplementary regulations section: Parking formula: Required spaces: Y/N Items to be verified in the field: Inspector : Notes: Date: Violations: Y' /N If so, List: Proffers: Y/N If so, List: Variance: Y/N If so, List: SP's: Y/N If so, List: Clearances: SDFIS Revised 7/1/201.1 Page 3 of 3 CERTIFICATI ®N 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. p p 1 certify that notice of the application, b Lull [County application name arM number] was provided toj��l,l L G the owner of record of Tax Map [name(s`)�of the record owners of the parcel] and Parcel Number i`- ,3/ aQ —0 0-00 —Q qf,4 C% by delivering a copy of the application in the manner identified below: Hand delivering a copy of the application to V\ &U )A 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 S�Cr iv Print Applicant Name Date Charlottesville Warrior Lifting Challenge To Benefit the EOD Warrior Foundation This event is to be held at the parking lot of Snap Fitness Hollymead and Kohl's. It will take place Saturday, May 3rd , 2014 from 10 -1pm. The event will have registered participants who will compete in three lifting challenges. All equipment is furnished by Snap Fitness Hollymead. We will have trained fitness professionals and EMT on site. Our sponsors will have tables set up for event goers to browse. We will also be having a live remote with 101.9 There will be water, Gatorade and donated pizz Our sponsors are ETM Soccer Academy, OFF Le; Ntelos, 7 Tigers Taekwondo and Hapkido, Hepp Wellness Center and Therapy Vets. All proceeds will be donated to the EOD Warric 0 4 4 �I .- g ku f11t k +� M' r .,_,4� � ,�nk'1- � 'fir._ r '� 1¢, t 4 a •y`k�� � .i:' � — °"`�"...4 !.,,:fJ�.1,. 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