HomeMy WebLinkAboutCLE201200039 Legacy Document 2012-03-01Application for Zoning Clearance
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CLE # WIZ --'A
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OFFICE USJ ONLY
31 I '2 ` - I z.
PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Receipt # Staff. m
PARCEL INFORMATION
Tax Map and Parcel: �v- szaB�Q�n Existing Zoning�r
Parcel Owner: Hansen Airport Plaza LLC
Parcel Address: 3500 Seminole Trail City Charlottesville State VA Zip 22911
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? Mr. Mark Smith
Address : 3549 Grand Forks City Charlottesville State VA Zip 22911
Office Phone: (434) 227 -4507 Cell # 987 -0568 Fax # E -mail mark @theshadesmith.com
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name _New business
Business Name /Type: TLg cl Ade- Smith, I I C
Previous Business on this sitel7� c.,,.
Describe the proposed business including use, number of employees, nu ber of shifts available parking ppaces, num er of
veh'cles pnd any additional information that you 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 accur to y vle . I have read the conditions of approval, and I understand them, and that I will abide by them.
Vthe
Signature Printed Mark Smith
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 C Date �a / ( zi
Zoning Official Date 7-A7 A6/2—
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:
Y /I�
Is us pin LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
�
Wil 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 or pblic wad ?
If private well, provide Health Dep ent 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 lnc� se ?
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 #
ZoninE to complete the following:
Reviewer to complete the following:
Square footage of Use: lo o o
/N
miffed as: t '4zi / v Y- F� 1 -AA-
Under Section: 2Z - /. �— CL
Supplementary regulations section:
Parking formula: /
�Z4'b ti
Required spaces:
Y / ,
Items to be verified in the field:
Inspector : Date:
Notes:
Viola ons:
Y/6)
If so, List:
Proff, rs:
Y/(
If so, List:
Var.' nce:
Y /NN
If so, List:
Y/N
If so, List: g /
crl
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3
L1..
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, Application for Zoning Clearance
[County application name and number]
was provided to Hansen Airport Plaza LLC the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number 03200.00 -00 -03800 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]
on
Date
X Mailing a copy of the application to Hansen Airport Plaza, LLC
[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 06?h 7 h2, to the following address:
Date
7232 Horizon Drive West Palm Beach, FL 33412
[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
Mark Smith
Print Applicant Name
0-2// -7
Date
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A) 952W 1 STORY RETAIL
B) 2082ftz 1 STORY RETAIL
q 728W 1 STORY RETAIL
D) 1400ft2 2 STORY RETAIL
E 16 38 tu 5u
24 16 B
42 28
f28 228 D
38
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