HomeMy WebLinkAboutCLE201500021 Legacy Document 2015-02-18Application for Zoning Clearance��,:-
CLE # Zb 5 - 2-
OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS Checl(# [ ) 52 Date:
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: Existing Zoning I
Parcel Owner:
Parcel Address: W vo VIC) City �i y') State V Zip�L�tbj
(include suite or floor)
PRIMARY CONTACT 70qlSJ-moi 6064igowX/yJ'
Who should we call/write concerning this project.
Address: ?332 6OMW00p c f,2, City t!,H19xWr7E5yt tate 01 Zip !:Ja /
Office Phone: (_� Cell # 47.37 E -mail ?7'6 -taw a-el4r*& 91±ik%-
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name e/ New business
Business Name/Type:
Previous Business on this site h ^ _0
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: „va CmWWYESS / < •
lyeis i�� /'vlSri%4 rse. rrr��
*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 he best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed 9////
APPROV INFORMATION
><' Approv d 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 _,4_1 I a L
Zoning Official Date : /: � 2,1�
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
Intake to complete the following:
Y
Is u LT, HI 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 o public ��ment
If private well, provide He 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 ublic sewer .
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit. 2
Permit #
Y/N
Will there be any new construction or renovations?
If so, obtain thep per Permit.
Permit #
Reviewer to complete the following:
Square footage of Use: /b O
v/N '
Permitted as:
Under Section: lZ
Supplementary regulations section:
Parking formula: jppsc,
Required spaces: I
Y/
Items to be verified in the field:
Inspector : Date:
Notes:
Zoning to complete the following:
Violations:
/N
If so, List:
f =X
Proff s.
Y/
If so, ist:
Variance:
Y/N(>
If so, List:
SP's:
/4/N
f so, List:
2 Sv
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,
[County application name and number]
was provided to
[name(s) of the record owners of the parcel]
and Parcel Number
manner identified below:
the owner of record of Tax Map
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
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].
r�
sigt tureb-f�Applicant
,yZtl'7Vn C F*6 b2 2 vHJ
int Applicant Name
Date
n
PLAN @ COUNTER
SCALE: 1"=l' -O"
ELEV.2
ELEV.1
P
CLIENT:
SIMON
JOB DESCRIPTION:
TWIST TAKE 2
JOB NUMBER:
96937
DATE:
05.29.07
DESIGNED BY:
EKN
DRAWN BY:
EKN
PROJECT MANAGER:
SHEET NUMBER:
1 OF 3
SCALE:
AS NOTED
QUANTITY:
TBD
Confidential and Proprietary. 'All Rights'
Reserved. Subject to Design Rights
Agreement between F.G Retail and Simo
Property Group.
EG Retaii'm -
4051 Stale Hwy. 121, Suite 100
GRAPEVINE, TEXAS 76051
TEL (214) 349-3515
Fax (214) 348-2449
www.e-gretail.com