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Home My WebLink AboutCLE201500203 Application 2015-10-13Application for Zoning Clearance - CLE # l O 1 S -- 401 OFFICE USE ONLY PLEASE REVIEW ALL 3 SHEETS Check# a11°I Date: )O" -� Receipt # Staff• PARCEL INFORMAT O Tax Map and Parcel: y a d d Existing Zoning PAOS C Parcel Owner: P/801 4 T F-0 VO Parcel Address: 49, _(�Emr/7 d'Ereal City (JuAbT&Vf19 State M Zip (include suite or floor) PRIMARY CONTACT Who should we call/write concerning this project? Caryl Purcell Address: 11518 Cedar Lane City Ashland State VA Zip ,23�0/05 Office Phone: C804} 368-0612 Cell # Fax # E-mail APPLICANT INFORMATION vv Check any that apply: Change of ownership Change ofuse— �-Change of name New business Business Name/Type: _ _ / —.FIK ��/ yI 111,'%6,11661 CCA V6M ('C, Previous Business on this site 7-Eleven 11136J Describe the proposed business including use, number of employees, number of shifts, avails le par in s aces, umbe f vehicles, and any additional info ti th t you can rovide: fE�! M Allemellee , r $► Sf�1 s UEh,CI�s �o rV S S __X'151 f7ry- *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 Iocation, 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 AM the conditions of approval, and I understand them, and that I will abide by them. Signature .AiLeW, AM Printed 00�� (� (CE It � 1` Q I-1 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: Building Official Date Zoning OfficialD_4;3�ate Other Official A—D Date %U / ZAL� 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: YIN Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. /10 11 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 wellpublic wat If private well, provide Hea partment form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE _ Circle the one that apli Is parcel on septic r public sewerI Y ON Wi you be putting up a new sign of any kind? Sign permit. Permit # If so, obtain proper Y I Will ere be any new construction or renovations? If so, obtain the proper Permit. Permit # Zoning to complete the followine: Reviewer to complete the following: Square footage of Use: —;- )2/N Permitted as: Under Section: Supplementary regulations section: Parking formula: I/ 1465 Required spaces: Y/N Items to be verified in the field: Inspector : Date: Notes: Viola' ns: Y/ If so, ist: Pro ers: Yl If so, ist: V rianee: If so, List: `71-1 SP's: Y TL If so, ist: 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, '� 1l ;�Z &I Ar Zq %j q (?/M ✓(tw1 [County application name number] was provided to kEn r A ✓0 r the owner of record of Tax Map [name(s)-of the record owners of the parcel] and Parcel Number �1 5C' - a ;apo by delivering a copy of the application in the manner identified below: Hand delivering a copy of the application to [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 �n l-� v O �VQ r, &JA19- YU MaiIing a copy of th plication to Van �r Af'llr �()$ / via U� [Name of the record owner if the record • er 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: _j&9,4 S&nil7 le 7>z�'l, Cha�lo ufll�', rA aa9el [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]. Signature of Applicant Anita Dahiya Print Applicant Name _ AUG2 8 201 Date I I — I ' L__J I s oP ¢Sic r9n= a.—a. �, ria oo rw o 13 7—ELEVEN STORE # 11136 1849 SEMINOLE TRAIL �'! o CHARLOTTESMLLE. VA M01-1129 - - kv; I I� - �■ oP ¢Sic r9n= a.—a. �, ria oo rw o 13 7—ELEVEN STORE # 11136 1849 SEMINOLE TRAIL �'! o CHARLOTTESMLLE. VA M01-1129 AMELIA LICENSING, LLC 1619 Woodbury Road • Walkerton a Virginia 23177 804-769-3981 officeMax August 28, 2015 RE: Power of Attorney for Anita Dahiya To Whom It May Concern: I, Anita Dahiya, Franchisee, hereby authorize Caryl Purcell, Ronald Maupin, and/or Neal Seay to act on my behalf to apply for, certify, obtain, or perform other processes to acquire all required licenses for my business, 7 -Eleven 11136G, located at 1849 Seminole Trail. Charlottesville, VA. 22901-1129. This authorization is effective as of the date of this letter and will be void after June 30, 2017. Anita Dahiya 13y: Name: Anita Dahiya Title: Franchisee Commonwealth of Virginia City/County of Virginia Subscribed and sworn to (or affirmed) before me this 28 day of August, 2015, by Anita Dahiya, personally known to me or proved to me in the basis of satisfactory evidence to be the person who appeared before me. Khaled Khasbroo Stamp Signature of Notary My commission expires on July 31, 2018 Registration Number 7591230 AMELIA LICENSING, LLC 111518 Cedar Lane r Ashland • Virginia 23005 804-368-0612 office/fax September 17, 2015 County of Albemarle Dept of Community Development 401 McIntire Road Charlottesville, VA 229024579 To Whom It May Concern, The 7 -Eleven Store located at 1849 Seminole Trail will become be franchised on November 16, 2015. I have attached a completed zoning application, a floor plan, my power of attorney, and a check for $50.00. I contacted the Health Department and was informed they do not cover 7 -Eleven stores. If any additional information is required, please contact me at 804-368-0612 or ca 1. urcell amelialicensin .com- We would like to pick up the approved zoning clearance if at all possible. Thank you for your assistance, cal V-Iao Caryl Purcell Licensing Specialist Amelia Licensing LLC