HomeMy WebLinkAboutCLE201500062 Application 2015-07-29U-WUttat.-Oc
Application for ZoninClearance
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CLE # �0 S 6 ;_9
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OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHE,
Check # Date:
Receipt # Staff:
PARCEL INFORMATION/
Tax Map and Parcel: (�`1 �p �'b�'-OD " f�D 1 !� U Existing Zoning M D
1. )o/
Parcel Owner: I�G`�) VC'166's P��, M0Ur1l7'V
�1 n
ParcelAddress:�(,' v i'pr� -�rr�s City L V11 1 � State ✓P' zip911
(include suite or floor)
PRIMARY CONTACT
Who should we callhvrite��c}}oncerning this project? � ��n� r%U►
Address: 1i1 i/V tyro hAY- � City VA Irf/ State V* Zip _7,2,41
Office Phone: (L_r J
� Cell # N-� -1 0 - Fax # E-maile'o 1�Q vul I Dc c ,
APPLICANT INFORMATION
Check any that apply: Change of Cbange of use Change of name New business
ownership
Business Name/Type: T)DA�JI-QA Dlitt'i h IUY)
Previous Business on this site [�1
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 provider
*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 knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature / P U Printed 061 Y(11'1
� M
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AP OVAL 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 �-
Zoning Official Date
/ .)--I'
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voices (434) 296-5832 Fax; (434) 972-4126
Revised 7/1/2011 Page 2 of 3
9.Um
Intake to complete the following:
Y
Is u n 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 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 welly public water?
If private well, provide Zltli t3sp ert orm.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applie
Is parcel on septic or plublic sewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit. lv � (.p O n , ,�_A I t
Permit # Q� X17 1�1� vc� {��
Y /�J
Will • ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use:
eerN
mitted as:
Under Section:
i
Supplementary regulations section:
Parking formula: 1
Required spaces:
Y/
Item be verified in the field:
Vio�ati ns:
Y/LNJ
If so, st:
Proffers:
Y/N
If so, List:
Variance:
Y/N
If so, List:
SP's:
Y/N
If so, List:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3
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]
was provided tor�5 (�(Gv s lith MMitryi;l the owner of record of Tax Map
[name(s) of the record owners of the arcel]
and Parcel Number d I� (p " �7� '"'W (7271 �j� by delivering a copy of the application in the
manner identified below: f r '
'� IIand delivering a copy of the application to '4 i rA 5�a j - , 0(1(r(�1
[Name of the record owner if the record owner is a'
person; if the owner of record is an entity, i dentify the red pient of the record and the recipient's
title or office for that entity]
on 15 '
Date
Mailing a copy of the application to
[Name of the record owner if the record owner is a person;
if the owner of record i s an entity, identify the red pi ent of the record and the red pi ent' s ti tl a or
office for that entity]
on
Date
to the following address:
[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].
" of ��ij. ant
6t byyhm
Print ApplicaNaive
Date
cL
.._ —/ J/—• --- — j . \`:.tiny ..� tt "'lyr
youth �uathlon
_Co�rs�
oD!il250m 1056ft tr .•,•:' r/
K F. PAith Line
boon
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c� I i`1 �J71C-�`Y K : �.h f3' n
�`u Y Yl Ll:r2�'v�r7�'\ �; -G� i(' � - � i L � 'C11 C� S � bC-I-h 1'I%�1 i �. t�S� 1 "� E t � •�' ��>' � � ���-by- r ceocj�+�n tur n Naun d. Y.
Commonwealth of Virginia
Department of Transportation
7/2010 (B�
11
LUP-SEA
LAND USE PERMIT
Special Events
Approval Form
L1a a--)�d J -e
-
APP OVAL DATE C) UNTY ADMINISTR TOR /TOWN MANAGER OR DESIGNEE
_January 13, 2015_ Sergeant Miller Stoddard
APPROVAL DATE LOCAL LAW ENFORCEMENT AGENCY
Remarks: The Albemarle County Police Department is in approval of the Dogwood Duathlon that will take place on
May 10, 2015. I, Sergeant Stoddard, have reviewed the race course and spoken with the race organizers. The race
will be staffed with contractual officers at various posts along the route. This event does not create any public 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/Town Administration
Local Law Enforcement
Virginia State Police
VDOT Maintenance Residency Office / AHQ