HomeMy WebLinkAboutCLE201500110 Application 2015-06-12Application for Zoning Clearance
G ✓
CLE # Z[�7 S -' ) � (�
A '
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY ,
Check # L �O Y 3 Date: Z`6
Receipt # q9 'A Z y Staff:
PARCEL INFORMATION
(P '" 1�
Tax Map and Parcel: _ �l 7`I Existing Zoning 1
Parcel Owner: Edens
Parcel Address: 2075 Bond St. Suite 150 City Charlottesville State VA Zip 22901
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? Andrew Hoffman
Address: 7404 James Madison Hwy City Gainesville State VA Zip 20155
Office Phone: ( ) Cell # 703.419.0470 Fax # E-mail andrew.jsquareps@gmail.com
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name X New business
Business Name/Type: The Edge By ACAC
Previous Business on this site N/A
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:
health club facility, workout classes and open gym, locker rooms for members
*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 accurat he best of In kno ledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed )44c> %Z r-� ��IG 69'lll
�1� - - / I//
APPROVAL INFORMATION
'j 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 �— Dates c a
Zoning Official 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
to complete the following:
Y G)
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /0
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 ublic water?
If private well, provide Heal e artm - rm.
Zoning review can not begin until we receive approval fi•om Health
Dept. FAX DATE
Circle the one that a ' s
Is parcel on septi or public sewer.
YPyo,
We putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
]�)/ N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #S2-0 1 'S -- 9 -7q Ari
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use:
Permitted as:
Under Section:'J1—M4r L, G' O Y>
Supplementary regulations section:
Parking formula: �
) ri
Required spaces: SS
Y /,
V
be verified in the field:
Inspector : Date:
Notes:
Violations:
CSS/N
If so, List: s1 � /�so,
offers:
/N
aList:
Variance:
O/N
If so, List:
SP's:
Y/�
If so, List:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3