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HomeMy WebLinkAboutCLE201500086 Application 2015-06-01Il+ Application for Zoning ClearanceCLE 0- # ,-V� — � OFFICE,USE ' (D PLEASE REVIEW ALL 3 SHEETS Check # Date: Receipt # Staff: _ \,Ui-- PARCEL INFORMATION •I Tax Map and Parcel: r �D _ Existing Zoning ��t' �` Parcel Owner: rAuv, 41 Ifni ✓i,�7+IVB 1 �t� �'`� l� �'�u� Parcel Address:�! �� i7 t/giig, City ':�4+1A-r\L©i 1Ce1V (44&c 'V� Zip ZZai (include suite or floor) PRIMARY CONTACT 7^ Who should we call/write concerning this project? I C�N� Address ��d►.0� !'%Dam/5ro'lA/�D City GA -1 —�IiWd State YA Zip Office Phone: ( .� 42,-q 1�31Cell # t f. 1 3 1{a , # E-mail 132LL�+aw !%L— APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business �htk'%'dti Gvyta' Business Name/Type: Previous Business on this site ✓1A1 ill i L4 Describe the proposed business including use, number of employees number of shifts, available parking spaces, number of C K Ru -J To 13f5, + ° 'f'N'5- vehicles, and any additional information that you can provide: Ln,& Lr LIAR tr -)9V: Z ©GIkL• � R cJ �A�G�i2 0'�Gi �'7 Y t t t Lr7 %%Y Sl t `— S; f��4'i i�r,.idr7N 9T Tl�� G —� K 7 Iafl �N:5 .0W T7 PAR Kt.9.1(sr o.tii � L �' � c� � MA•►Z, V *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 the best of my wwledgge. I have read the conditions of approval, and I understandm, and that I will abide by them. Signature %r ��� Printed ,%M� � -- APYAOVAL 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. it is a determination of compliance with the existing [ ] No physical site inspection has been done for this clearance. Therefore, not site plan. [ ] This site complies with the site plan as oAtihis date. y l� y 1 Notes: Building Official r_ Date Zoning Official Date '� t 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 �r3 Intake to complete the following: Y / Is us 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 p lie wat If private well, provide Health epartment form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that appli Is parcel on septic o public sewez•9 Y WiQN beputting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Y/ Will ere be any new construction or renovations? If so, obtain the proper Permit. Permit # Zoning to complete the Violations: Y/N If so, List: Vari, ce: Yf s/ Io, .st: Clearances: 96 G —I 6 n Reviewer to complete the following: Square footage of Use: N Under Section: Supplementary regulations section: Parking formula; '13 Required spaces: Y / �(� Prof s: Y/N If so, ist: 7's: Y/N di•so, List: SDP's—L-A - U Revised 7/1/2011 Page 3 of 3 Commonwealth of Virginia Department of Transportation 7/2010 W i hq� APP OVAL DATE Remarks: a COUNTY LUP-SEA LAND USE PERMIT a Special Events Approval Form / TOWN MANAGER OR DESIGNEE June 1, 2015 _Sgt Miller Stoddard APPROVAL DATE I LOCAL LAW ENFORCEMENT AGENCY Remarks: The Fairview 5k will be run in the area of Huntington Drive on July 18, 2015. This event has been approved by the Albemarle County Police Department. The Fairview 5K is a yearly event that causes no concern for traffic or public safety. The event will be staffed by contractual police officers. 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/Town Administration Local Law Enforcement Virginia State Police VDOT Maintenance Residency Office / AHQ ^RNs http://maps.google. c.om/maps/ms? ie=UTF8&h 1=e,n&msa=0&11=3 8.07,: Icz t , °9'go ;'� r • r ' IQs ��,`. � ��ng _� i k'`re; . 8, • ''r o �� ' •Rd .i / : G�• � �fi:�,. Wit.-.,:' ,?: • .. U, ' ''OpQ6%' !�'' _ -' , ate' • .,• .. v Q S SOT �• -. �'•.�t, •• , a � rO�kG'.v f1 i 910--� : •'" \ ,• ' '';$ .,Sd�' �: ,fila • a t ';'., ,' r' —• `' ••`�` .�,;: ., '� iia•.•''. .,, �' � r' •,�-t tor... � ,. °r ra ashfartSquafn 4 f o / 4bi IYA ,•.f` i�1 A% �y . C Go G� Old crook � d t* or e C}r `+115d%'gfl� 10 • ®y7 j,/ /r� � ye�!e R r' Z" Nafihfields Waketreld. 70 COR7Goocl�t n°niceCn 1:/ .0 ur� .r1is; lviap d%Ce12f7D7 NAV7EQTM Loading Print Preview... F I 7114MnWr i.IZa DTA °O == FAI RVi E __ pmralqk=�M-W 111141P Saturday, July 18, 2015, 7:30 a.m. Mountain 14rru�rcara RunningCa,ce�r Charlttsshop vitle 1 reit Club SocieltY* 's Efi%� Ave ChUkfi=A1MV,1 A benefit run for the American Cancer Society in memory of Betty Seay and Chrissy Chadwick - {All proceeds donated locally) Online Registration: https:Hwww.raceit.com/Register/?event=31067 (closes midnight 7/16/2015) Location: Fairview Swim and Tennis Club (Directions: www. fairviewdub.orQ) Registration: $22.00 ($21 CTC Members) on or before 7/10/15. $25 after 7/10/15 or on race day Make checks payable to Fairview Swim and Tennis Club By Mail: 1783 Bentivar Farm Rd., Charlottesville VA 22911, or Drop off by noon 7/16/15 Ragged Mountain Running Shop (293-3367) Awards: Tech shirts for All Registrants; Door Prizes and Age Group Winner Awards. Name: Tech T-shirt unisex size (circle one): S M L XL Address: Email address: Phone: Age on race day: Gender: M / F CTC Member? Y / N WAIVER: MUST BE SIGNED BY PARTICIPANT AND BY PARENT OR GUARDIAN IF UNDER 18. I know that running a road race is a potentially hazardous activity. I should not enter and run unless I am medically able and properly trained. I agree to abide by all decisions of the race officials relative to my ability to complete the run safely. I assume all risks associated with running in this event, including, but not limited to, falls, contact with other participants, effects of the weather, including high heat and humidity, traffic and the conditions of the road, all such risks being known and appreciated by me. Having read this waiver and knowing these facts and in consideration of your accepting my entry into this course, I, for myself and anyone entitled to act on my behalf, waive and release the Charlottesville Track Club, the County of Albemarle, Fairview Swim and Tennis Club, and all sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in this event. In consideration of the safety of all participants, I understand that absolutely no baby joggers, baby strollers, headphones, animals on leash, skateboards, skates, rollerblades or bicycles are allowed on the course. In addition, I understand that if the race is cancelled by circumstances beyond the control of the organizers, my entry fee will not be refunded. SIGNATURE (parent or guardian if under 18) Date Rebecca Ragsdale From: Tom Scala [tscala1 @gmail.com] Sent: Wednesday, April 29, 2015 11:34 AM To: Rebecca Ragsdale Cc: Miller Stoddard; Garrison, Amy (VDOT); Dennis Seale Subject: Re: Fairview Swim Club 5k -July 18 Attachments: 2013 Special Events Check List.pdf; LUP-A Land Use Permit.pdf; LUP-SP Land Use Permit (special provisions).pdf; 5K course map.pdf; Entry form_2015.doc Rebecca, Miller, Amy and Dermis, Here are the appropriate attached forms (hopefully filled out correctly) for the 19th running of the Fairview 5k on July 18th, 2015. Let me know if I need to hand deliver all the paperwork that didn't require my signature, and I will. The course is the same as we have staged in past years. Fairview is a non-profit organization, and all proceeds from this event go to the local chapter of the American Cancer Society to honor of the memory of Betty Seay and Chrissy Chadwick (Fairview members who died of breast cancer). Everything but the race takes place on Fairview's grounds, and it will be the same as it was last year and the year before, etc. Thank you for your help, as this is the first time I've had to fill out these forms. Tom Scala 434.981.1324 (c) On Mon, Apr 27, 2015 at 3:55 PM, Rebecca Ragsdale <rra sg dale(2calbemarle.org> wrote: Mr. Scala, Here is a link to the zoning form (below). Please provide a snap of the route, race details, and map if there will be any set-up of tents, etc. htt-p://www.albemarle.org/upload/images/forms center/departments/Community Development/forms/applicatio ns/Zoning Clearance.pdf No fee is required if this is a non-profit fundraising activity. If it doesn't require the fee, you can email me the zoning clearance form. Please get in touch with Albemarle County Police Department and VDOT regarding any requirements they may have for the event. They are also copied on this email ACPD contact is: Sgt Miller Stoddard ACPD Traffic Unit stoddardm cgalbemarle.org c: c. a VDOT contact is: Amy Garrison Area Land Use/Permits Albemarle & Greene County Charlottesville Residency 701 VDOT Way Charlottesville, VA 22911 (434)-422-9399 Amy.Garrison@vdot.vir ig nia. ov Rebecca Ragsdale. Senior Planner County of Albemarle Department of Conmiunity Development 401 McIntire Road Charlottesville, VA. 22902-4596 (434) 296-5832 Ext. 3226 E-mail: rragsdale 1ualbemarle.org 2