HomeMy WebLinkAboutCLE201400105 Application 2014-06-13Application for Zoning Clearance``'
OFFICE USE ONLY �"
Check # 4047591031 G `, Date: 17
PLEASE REVIEW ALL 3 SHEETS
Receipt # Iq a1 Staff: Piz
PARCEL INFORMATION ) �j
`i )6 A I
Tax Map and Parcel: -+ / Existing Zoning 01 <�byyi" I GZ ay
Parcel Owner: GRAND PIANO FURNITURE COMPANY
Parcel Address: 1801 SEMINOLE TRAIL City CHARLOTTESVILLE State VA Zip 22901
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project?
5501 HEADQUARTERS DR ATTN: TAX DEPT
Address : City PLANO State TX Zip 75024
Office Phone: 800 275 -2696 Cell # Fax # 972 - 801 -1471 E- mai1TAXISSUES a(�RENTACENTER.0
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name X New business
Business Name /Type: RAC ACCPTANCE EAST LLC DBA ACCEPTANCE NOW 09554
Previous Business on this site
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 provide: RFNT To (AWN of nl IRARI F Hot 1SFHoi n noonS
3 EMPLOYEES 100 SQ FT LOCATED INSIDE OF GRAND, HOME FURNISHINGS
*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 pennission 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.
L �
Signature Printed TERI KELLY
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,x]17.
[ ] 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 f Date
Zoning Official DateIV
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
UT
Intake to complete the following:
Y /�z
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/O
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 r public water?
If private well, provide Hea )form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that ap 'gs•-
Is - p-ar�cel on septic r public sewer?
Y / (�U
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y0
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: 366
D/N
Permitted as: o G�
Under Section:
Supplementary regulations section:
Parking formula:
�%6
Required spaces: , ,Z_,,,
Y/
Items to be verified in the field:
Inspector
Notes:
Date:
Violations:
Y/6
If so, List:
Proffers:
Y/
If so, List:
Variance:
Y / (6
If so, List:
SP's:
Y /
If so, ist:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of
M
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,
ZONING CLEARANCE
[County application name and number]
was provided to GRAND PIANO FURNISHINGS the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number 1801 SEMINOLE TRAIL
manner identified below:
by delivering a copy of the application in the
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
X Mailing a copy of the application to GRAND PIANO FURNISHINGS
[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 05/28/2014
Date
to the following address:
4235 ELECTRIC RD. STE., 200 ROANOKE, VA 24018
[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].
SignatL •e ofApplic nt
TERI KELLY
Print Applicant Name
05/28/2014
Date