HomeMy WebLinkAboutCLE201600065 Application 2016-03-28r51.
Application for Zoning Clearance l
CLE 1 U - (0 ,
OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS Check # -S Date: 3/1-7/1
Receipt # 10 g Staff: ERL
PARCEL INFORMATION p
Tax Map and Parcel; --Existing ZoningP. _
Parcel Owner: Simon
Parcel Address: 1621 Rio Road, Space# 1206A City Charlottesville State VA Zip 22901
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? Tammy Korte
Address :1950 Craig Road City St. Louis State MO Zip 63146
Office Phone;3( 14 415-2400 Cell # Fax # 314-415-230(k-maii tkorte@arcv.com
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type, Spencer Gift ' S LLC
Previous Business on this site Health Plan Massage
Describe the proposed business including use, number of employees, nuMhershifts, available parking spaces, number of
vehicles, and any additional information that you can provide: spec;aPT) V4.. CiI Store, 3 max employees per
shif f - Mail parking to remain
*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 accura to t e best of my knowledge, I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature
�e- Printed Tommy Korte
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, itis nota determination of compliance with the existing
site plan.
[ ] This site complies with the site plan as of this date.
Notes:
Building Official Date 3
Zoning Official AA Date�z
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 295-5832 Fax: (434) 972-4126
Revised 7/1/2011 Page 2 of 3
Intake to complete the following:
Yl
Is us n LI, HI or PDIP zoning? 1f so, give applicant a Certified
Engineer's Report (CER) packet.
Y
Wi iere 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 ��4«
Is parcel on private well or ublrc wa ?
If private well, provide ReaIt artment 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 is s ~ er?
YIN
Will you be putting up a new sign of any kind?
Sign permit.
Permit #
Reviewer to complete the following:
Square footage of Use; YJ
6IN.
Permitted as: g --
Under Section:-�
Supplementary regulations section:
Parking formula:Jf a
<63 �YfY> SL �%✓ r1 J t±
Required spaces:
YI
Items ber verified in the field:
If so, obtain proper
Inspector : Date:
Y / N Notes:
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
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wauaa
Viola ions:
YI'
If soist:
Proff rs:
Y16
If so, List:
Variance:
Y
If so``{{ ist:
SP's:
(t>IN
If so, List:
Clearances:
SDP's
Revised VI /2011 Page 3 of 3
CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
This farm 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, AbbemarleCounfy Building - -5832 x3024
[County application name and number]
was provided to Simon Property Group the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number
manner identified below,
by delivering a copy of the application in the
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 .
X _ MaRing a copy of the application to Simon Property Grou
[Naive 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 March 14, 2016 to the following address,
Date
225 W. Washington Street Indianapolis-
[address; written notice mailed to the owner at the last known address of the owner as shown on
the current realestate tax assessment books or current real estate tax assessment records satisfies
this requirement].
igna re of Applicant
Tammy Korte
Print Applicant Name
March 14, 2016
Date