HomeMy WebLinkAboutCLE201100163 Legacy Document 2012-04-11Application for Zoning Clearance
CLE # ;L C)0 I
OFFICE USEN Y ,
PLEASE REVIEW ALL 3 SHEETS
Check # ' Date: — a —I1
.
Receipt # _ _Staff:.
PARCEL INFORMATION
Tax Map and Parcel: Existing Zoning
Parcel Owner: THE BUCKLE, INC. (C /O ALBERT GARCIA)
ParcelAddress?600 Rio Rd E. -Space No. 121tty Charlottesville State VA Zip 22901
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? ALBERT GARCIA - STORE PLANNING DEPT.
Address : 12915 Jones Maltsberger Suite 302CitySan Antonio State TX Zip 78247
210.545.1907
Office Phone: (� Cell # 210 .2 62' . 4 0 6 6Fax # 210.54 5.9517E -mail ALBERT .GARCIA @BUCKLE . COM
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name X New business
Business Name /Type: RETAIL - CLOTHING
Previous Business on this site RETAIL.
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:
*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 I the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed ALBERT GARCIA
APPROVAL INFORMATION
f 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 fZN_ - Date-
o
,r
Zoning Official �r�, e Datei/
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 /�
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
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 put lie wa ?
If private well, provide Health Dl aZer form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that ap li
Is parcel on septic,or ulst c ewe ?
Y /O
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 # �- -v ff— / el p 4 U
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: 'I"/
( /N j
Permitted as:
Under Section:✓•
Supplementary regulations section:
Parking formula:
k,�6;�t
Required spaces:
Y/
Items to be verified in the field:
Inspector•
Notes:
Date:
Of iolations:
N
so, List:
Proffers:
/
Ifs , ist:
L
Variance:
6/N
If so, List:
SP's:
/
f so_, ist: .
Clearances:
SDP's
Revised 7/1%2011 Page 3 of 3
v v
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]
KENDRIC IIASLETT - TENANT COORDINATOR
was provided to SIMON PROPERTIES. the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number 06100-00-00-13100 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
KENDRIC HASLETT - TENANT COORDINATOR
X SIMON PROPERTIES.
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 8/12/2011 to the following address: .
Date
SIMON PROPERTIES - 225 W. Washington St. - INDIANAPOLIS, IN 46204
[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
ALBERT GARCIA
Print Applicant Name
8/12/2011
Date
c
CURRENTLY
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DBA Name: Date: 02f08I2011 8:47
Unit No, 12146 Scale: '1 = 20`
Leasing Agent: BARRY ELLISON Corp. No. 4663 1
EXHIBIT "A”