HomeMy WebLinkAboutCLE201500243 Application 2015-12-03Application for Zoning Clearance �d
CLE #_; .},.
OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS Check # Date:
Receipt #ju
d2N:_:Staff:
PARCEL INFORMA O
Tax Map and Parcel: oo 60 + Existing Zoning _a _
Parcel Owner:—(7,1 V (1 l +
Parcel Address: 391 L & m;,aoV ,TmJ City Cbl r Im {Su; k: e State A Zip 2z9d
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? _ G r z!)
Address : ?a2LI , City State Zip 22-7
Office Phone: (_ _ ) Cell # 5q6 ,? 77 _z1 Wax # E-mail hrn c - r o"I a. f-"
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name >' New business
Business Name/Type: Ste- 14 Uc
Previous Business on this site �—
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicles, Id any additionaj 'nformatio that ou c o provide:. _ _ _
P ^^
*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 myledge. I have read the conditions of approval, andI understand them, and that I will abide by them.
Signature 0 Printed Ellen SC i r O c.l
APPR�'dAL INFORMATION
[or pproved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, x117.
[ ]>y sical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
s e plan.
[ ] This site cpmplies with the site plan as of this date.
Notes
Building Official Date�11 ! f r -� _
Zoning Official Date 1 9L l c7
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 11/1/2015 Page 2 of 3
Intake to complete the following:
Y
Is On LI, HI or PDIP caning? If so, give applicant a Certified
Engineer's Report (CER) packet.
0ilN
l 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 Ada -
Circle the one that applies( SIII �.ft j� J
Is parcel on private well or public wet ?
If private well, provide 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 septic or public sewer?
YIN
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
YIN
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the`}}fopRllowing:
Square footage of Use:q(;J1(,f
N
Permitted as: II i
Under Section: 1�
Y%1(b1k1C�
Supplementary regulations section:
P k5ing formula :VzVm
J }.fi, Je-
5 t -�- 61-1 tiff
Req 'red szaces:
Y/N
Iter be verified in the field: 6)
Viol ons:
Y1
If so, ist:
ProffgrN
Yl
If s , st:
Varia ce:
Y / Y
If so ist:
SP's:
If
;)
If so, st:
Clearances:
SDP's OA AA
Revised 11/1/2015 Page 3 of 3
MONDAYtiSATi MAY
9:30-5:30
FABRICS
UNUMIRlo
DRAPERY • SUPCOVER • UPHOLSTERY
SUPPLIES • FOAM • TRIMS
3912 Seminole Trail, Charlottesville, VA 22911
434-973-5641
d9wrak4f66riewnlirnNWw.00m
To Whom It May Concern:,
's bonuts 4 LLC
.ochelle School Lane
chelle,VA 22738
540-272-2196
Please sign below to say that we have your permission to sit on your lot to
sell donuts from our donut trailer.
-We ask for 2 weeks of free rent to see if there is a chance that we can
make a profit.
-We will pay you $50.00 a week to sit on your lot. This amount will be paid
on a monthly basis on the last Thursday of each month.
-If we see that we cannot make a profit you will be notified 2 weeks prior
to us pulling out.
-We will make check payable to: Fabrics Unlimited
ited
Thank you,
Ernest Schrock
your signature is your agreement to the above contract.
date
COMMONWEALTH OF VIRGINIA
DEPARTMENT OF HEALTH
CERTIFIES THAT
Schroth, Ernest A Ellen
is hereby granted a permit/license to operate as a
Nobtte Fond unto
by the Greene County Health Department in accordance
with the regulations ofthe Board of Health ,
Commonwealth of Virginia.
FACILITY NAMD STRITES DONUTS 4 LLC
PHYSICAL ADDRESS: 86TI Seminole Trail
Ruckersville, VA 22968
MAILINGADDRESS. 324 Rochelle School Lane
Rochelle, VA 22738
UPIRATION DA'rlr: March 39, 2016
CONDITIONS:
Alae Max wski
Environmental Health Specialist, Sr.
Please direct questions or concerns to the
Greene Count�v Health Department,
Environmental Health Services, (434) 985-2262.
This Permit Is NOT TRANSFERABLE From One Individual