HomeMy WebLinkAboutCLE201200020 Legacy Document 2012-02-06Application for Zoning Clearance
CLE # 20)2. - ZU
is
PLEASE REVIEW ALL 3 SHEETS
OFFICE U ON
Check # ` Date: ' Q Z
Receipt # Staff:
PARCEL INFORMATION V
-Z'
Tax Map and Parcel: Lo t 3-11 A Existing Zoning
Parcel Owner: C 4A2. L, C) iTe-SQ ILL E- Al2Lq �SSOC. 04- 12Ct4 L_7V 2S
Parcel Address: AE5_5-2 1 - S DALF 1:5a City CF(0(_l,b 1(�SghLLEState vA Zip
(include suite or, floor)
PRIMARY CONTACT
Who should we call/write concerning this project?
Address :_5(,.6C) �OGI-(Qg 7b City. State U Zip ,2_4W
Office Phone: a 3Cell #t�y �' 3 g�I 1�Fax # 5'�iD �i''S� I9 ail I ,(CiO2, e�
APPLICANT INFORMATION ' scot, C
Check any that apply: Change of- ewer -sltip Change of use Change of name New business
Business Name /Type: �� P V L ML92
ONE
Previous Business on this site 7E1q L E-57_ T F 1J E F I_L, y NCI W-7 fj Zi 1,J E
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
Cry
vehicles, and any additional infor tion that on can provide � /?
*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 e best of m ledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature _ ' 2p&L'��i' 1 Printed
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, 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 Date
Zoning Official 1.� , 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 7/1/2011 Page 2 of 3
Intake to complete the following:
Reviewer to complete the following:
Y / U Square footage of Use: I �u
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet. fj / N (�
Permitted as: D C�'�C �✓
Y / N
Will • ere be food preparation ? -- _ - - - -Under Section:---- - Z2 -
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from Health Supplementary regulations section:
Dept. FAX DATE
Circle the one that applies �--�
Is parcel on private well or "i ul er?
If private well, provide Heal ent form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that appii s
Is parcel on septic or u lic sewer
Y/N
Will you be putting up a new sign of any kind? if so, obtain proper
Sign permit_
Permit #
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Parking formula
Required spaces:
Y/N
Items to be verified in the field:
Inspector:
Notes:
Date:
Violations:
Y /M
Ifs Est:
Proffers:
Y/Q
If so, ist:
Vari ce:
Y
If so,' 1st:
SP's:
Y/
If so, List:
Clearances:
SDP's
Revised 7 /1/2011 Page 3 of
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, T�Z 01 Z l S
[County application name and number]
was provided to C AWq E the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number ct i A by delivering a copy of the application in the
manner identified below:
Hand delivering a copy of the application to / I r kzr, cE o
[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 O 12 ` 1Z
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 to the following address:
Date
[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
6( s-, -;I� _ x0�ly -
Print Applicant Name
// pJ4� %'
Date
Zoning Clearance Checklist
Applicant MUST HAVE the following information to apply for a Zoning Clearance:
1) Tax Map and Parcel or Address, Building Name, Suite/Unit/Floor numbers, if applicable.
-- 2) A Floor Plan - either a sketch or an architectural drawing -
a) If using less than the entire structure, note the location within the structure;
b) Note the total square footage of the use;
c) Note the square footage of each room or area of use;
d) Note the use of each room or area of use.
3) Certification that notice of this application has been provided to the property owner, if owner is
different from applicant.
FEES
Zoning Clearance = $50
Temporary Fundraising Activity = No fee
Conditions of Approval
FIREWORKS:
1. No person shall sell, offer for sale, store, display or discharge any fireworks in any filling station or on any premises where gasoline
or other inflammable liquids are stored or dispensed. (Code 1967 10 -13.) County Code Section 6 -200 and 6 -300 and must be a
minimum of 100 ft from any gas pumps /propane distribution tank.
2. The site shall be cleaned and restored to its original condition on or before July 11 th. This shall include removal of all structures,
signs, debris, and the like.
3. A thirty (30) foot front setback shall be maintained, Display shall be located so as to avoid traffic congestion. Modifications subject
to Zoning Administrator's approval.
4. Building permits shall be obtained for all proposed structures and/or lighting.
5. Sign permits shall be obtained for all proposed signage.
6. The sale of fireworks requires a special permit from Fire /Rescue department.
CHRISTMAS TREES:
1. The outside storage of combustible material or flammable materials shall be located so as not to constitute a hazard and shall not be
less than 15 feet from any building on the site. Any open burning must comply with the Virginia Statewide Fire Prevention Code and
the Albemarle County Code.
2_ The site shall be cleaned and restored to its original condition on or before January 2. This shall include the removal of all structures,
signs, debris, and the like.
3. A thirty (30) foot front setback shall be maintained, Display shall be located so as to avoid traffic congestion. Modifications subject
to Zoning. Administrator's approval.
4. Building permits shall be obtained for all proposed structures and/or lighting.
5. Sign permits shall be obtained for all proposed signage.
OTHER REVIEWS:
1. Is the property on public or private water /sewer?
Private requires Health Department, Public requires ACSA review (2 to 5 days)
2. Will you be operating a bakery?
USDA review is required (approx. 2 weeks but as long as 6 weeks)
3. If you are serving prepackaged baked goods but not making them on the Premises, only Health Department will review. (2 to 5 days)
4. If you will be operating any business that is in an industrially zoned district or of an industrial nature you will need to provide a
Letter of Performance Standards or Certified Engineer's Report (a staff member will provide an information.packet addressing this
requirement) (5 to 10 days as soon as the better or Report is received by this Department)
5. If there has been no site inspection within the last three (3) months for the parcel/site, then one will be conducted to verify that the
project is in compliance with an approved site plan (if applicable).
Revised 7/1/2011 Page 1 of
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