HomeMy WebLinkAboutCLE201500163 Application 2015-08-05Application for Zoning Clearance
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OFFICEU E ONLY
PLEASE REVIEW ALL 3 SHEETS Check# Date:
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: 061 WO-03-00-019AO Existing Zoning
Parcel Owner: ALBEMARLE PLACE EAAP LLC
Parcel Address: P O BOX 528 City COLUMBIA State SC, Zip 29202
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? Bill Hellmann
Address: 319 Elaines CT City Dodgeville State WI Zip 53533
Office Phone: (_§08) 407-9081 Cell # Fax # E-mail Bill@permit.com
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name x New business
Business Name/Type: Kendra Scott Jewelers
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:
Retail shop
*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 Printed Bill Hellmann
APPROVAL 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:
<77--
Building Official _>4 Date fS
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
Intake to complete the following:
Y/N
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /(SN
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 Health epa ment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic o public sewer?
Y)/ N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit. under separate permit filing
Permit #
D/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit # 2n/s pending
ZoninL, to complete the following:
Reviewer to complete the following:
Square footage of Use: / 2-3
Permitted as: r4lq
Under Section: Jher►+gYle..v
Supplementary regulations section:
Parking formula: 9-1
Required spaces:
Y /
Items be verified in the field:
Inspector : Date:
Notes:
Violations:
Y/
If so, List:
Proffers:
/N
if so, List:
Variance:
0 / rN
If so, List:
SP's:
Y lb
If so, List:
Clearances:
SDP's
67'
/2 3
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 to ALBEMARLE PLACE EAAP LLC
[name(s) of the record owners of the parcel]
and Parcel Number 061 WO -03-00-019A0
manner identified below:
x
Hand delivering a copy of the application to
the owner of record of Tax Map
by delivering a copy of the application in the
[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
Mailing a copy of the application to ALBEMARLE PLACE EAAP LLC
[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
to the following address:
P O BOX 528 COLUMBIA SC, 29202
[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].
]ii6ref Applicant
Bill Hellmann
Print Applicant Name
7/24/15
Date