HomeMy WebLinkAboutCLE201500099 Application 2015-05-15Application for Zonin Clearance.
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CLE#. Z-O 1 S-
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OFFICE USE NI,Y _y�
PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: _ ,32- (00, !Ak0C;1 b, c CPs Existing Zoning
Parcel Owner:yr� �y�`( \['i Q cx
_CR:
Parcel Address: L^�\S-C'1C3etC \(P, Cit}Q'4,1�V\1\,� State U p, Zip 72x1 t 1
(include suite or floor) y
PRIMARY CONTACT
Who should eve call/write concerning this project? Cbc)nn, iZ, :es
Address: �pr'�S klPd�1 C7- C, njP' CityState Zip 22 P
Office Phone:Cell#E-mail Ce-(NAa��tQ1�Ya.0-C��
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Namc/Type: L 4-y, ),11c^s.soA� ec A , 5 k - lol 2615
Previous Business on this site-( ,)cs�&T cN� V,\T(, ;"- �&rxrch, PorK
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:
1 - Z c3
a*,e
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*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 Zomig
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 inforniation provided
is true and ac ate the best of my knowled . I have read the conditions of approval, and I understand them, and I will abide by them.
�that
Signature Printed_1%t���7't�
APP AL 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.
j ] 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 Date GJ�
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
Lxta to complete the following:
Y N
Is a LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y
Will
re be food preparation?
If so, give applicant a I•Iealth 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 public water?
If private well, provide 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 septic or public sewer?
'Y;4 N
tEl you be putting up anew sign of any kind? If so, obtain proper
Sign permit. �r
Permit # � Q
Y
W sere be any new constriction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use:
Y)/ N -- .
Permitted as:
Under Section: Gc I
Supplementary regulations section:
Parkingfornmla: 1 S
Required spaces: Sy -'
i
Y/N
Item o be verified in the field:
C`
Viiol ons:
Y/
If so"ist:
coffers:
Y/N
o, List:
Vari ice:
Y/
If so, tst:
�'s:
(fso,
so, List:
Clearances: ` L� R I$yls'
SDP's
06 1
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Revised 7/1/2011 Page 3 of 3
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Commonwealth of Virginia LUP-SEA
Department of Transportation LAND USE PERMIT
7/2010 Special Events
I (V Approval Form
May 15, 2015 Rebecca Ragsdale
APPROVAL DATE COUNTY ADMINISTRATOR / TOWN MANAGER OR DESIGNEE
Remarks:
_May 14 2015 Sergeant Miller Stoddard
APPROVAL DATE LOCAL LAW ENFORCEMENT AGENCY
Remarks: I, Sgt Stoddard of the Albemarle County Police Department, have reviewed the course map and the
VDOT Permit Application for the Wounded Warrior 5K to be held on June 6, 2015. The Albemarle County Police
Department approves of this event and I have no public safety concerns or traffic safety concerns.
APPROVAL DATE VIRGINIA STATE POLICE (Sergeant/Area/Division)
Remarks:
APPROVAL DATE
VDOT REPRESENTATIVE
Remarks (include any changes that may be made by VDOT):
Cc: County/TownAdministration
Local Law Enforcement
Virginia State Police
VDOT Maintenance Residency Office / AHQ