HomeMy WebLinkAboutCLE201500213 Application 2015-11-09Application for Zoning Clearance V"D'k't
CLE # C� l — 1
OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS Check # 27V O *� Date: !a j
Receipt # —1.0 15 it D Staff. ApQ-
PARCEL INFORMATIO
Tax Map and Parcel: G> ( Existing Zoning_��
Parcel Owner•• -C oM C'6'r, ce zP' C P,
S
�
VtParcel Address: 0&7d S City C �+�do4esv)L,State VA_ Zi L2 B
p
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? Andrew Hoffman
Address : 7404 James Madison Highway City Gainesville State VA Zip 20155
Office Phone: C703) 419-0470 Cell # Fax # E-mail andrew.jsquareps@verizon.net
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name X New business
Business Name/Type: LULULEMON
Previous Business on this site
Describe the proposed business including use, number of employ, dumber of hi#tss, available parking spaces, number of
vehicles, and any additional information that you can provide: _ �(Qtx eih wnf Lo e -M M. 4AW-5
*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 the b st of m know dge. I have read the conditions of approval, and I understand them, d that I will abide by them.
Signature Printed
APPROVAL INFORMATION
Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 9774511, 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 C � 6
Zoning Official / Date _ /i Z V /-7-,) Z.5 -
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:
YI
Is us m LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Yl
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 well or(Opb ' r?
If private well, provide HeaKar ent form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic or
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
IN
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit# 2a1�5A1�/
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: 2-57
Or/N
Permitted as: r c4fl 1 tkSe _
Under Section: 414,,AA1 Cv -PIAC6 L • OP
Supplementary regulations section:
Parking formula:
/26 ob NMI)
Required spaces: /2,
YI
Items to be verified in the field:
Inspector • Date:
Notes:
Viola* ons:
Y / IV
If so, List:
Proffers:
&/N
If so, List:
Variagqce:
Y/(b1)
If so, List:
SP's:
Y/N
If so, List:
Clearances:
SDP's
Pp
6 -7
_
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 to5 the owner of record of Tax Map
[name s) of the record owners of the parcel]
and Parcel Number by delivering a copy of the application in the
manner identified below:
_�ZHand delivering a copy of the application to nim
[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
Da
Mailing 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
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].
Z�1�11� -
ignature of- Ii/
21I W
tint Applicant Name
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Dat