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HomeMy WebLinkAboutCLE201600135 Application 2016-06-03Application for Zoning Clearance CLE # F , OFFICE NLY PLEASE REVIEW ALL 3 SHEETS Check # _ Date: Receipt # Staff: PARCEL INFORMATION Tax Map and Parcel: ��� /� Existing Zoning V Parcel Owner: PANT V03 PLfi%, L-L C- 71-050PH 5 I F1105 o N Parcel Address: 2040 A g 13EY P ©15 0TE 1 U3City Cam#' AP-LOTTES V f8tate VA Zip I ) (include ,suite or floor) PRIMARY CONTACT Who should we call/write concerning this project? CO L DE. L_UUV - <3A P'6EN ( i A P-GM (E C i-5 Address: �'�C I"1 �• 2N"-) FW0i- City f� R A H U S State N T Zip b &J L Office Phone: dB 2,53-' 93 Cell # Fax # E-mail t4t�C—i,U(Fli @ 5A9G A1aX1H, yd 1(16 APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business Business Name/Type: `i _ ' ti i iZPEVVAi,o Previous Business on this site A tiEW CON TA U C.TI o W - 5 RST 'N A; ; T I N 'S F A 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: PET yA t_1)12 E r-Ai L PE T SU FP L-'? 5TE®izc-_ W I-Tli DUhy4A5 ST% iE ::� ..'Tf-�a=12. wa L := A4 A-yF _it ` of 2 :MPLOYt- 5 Piz SH-i F""C ><4 N u Z sifil EMS ' _ '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 ? vO S696 F,I�T ( f�@C�f' 9ECPrr'lld hJ I CMG-L l -UPt 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, xl17. [ ] 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 Official W JAW Date ?3 Other Official Date County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 2%-5832 Fax: (434) 972-4126 Revised 11/02/2015 Page 2 of 3 Intake to complete the following: Y /lN J �-�Wow W 6K�[' b) <6-�� Reviewer to complete the following: Square footage of Use: f 3v3—,TA Is u LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. QrN itted as: I Y / 1Willre be food preparation? Under Section: If so, give applicant a Health Department form. Zoning review can not begin until we receive approval from Health Supplementary regulations section: Dept. FAX DATE Circle the one that applies Parking formula: Is parcel on private well or lic water'? S If private well, provide He ent form. k Zoning review can not begin until we receive approval from Health Required spaces: T Dept. FAX DATE _ Ph AV Y / Circle the one that applie Item be verified in the field: Is parcel on septic or p lie sewe ` Y/N ill you be putting up a new sign of any kind? If so, obtain proper Sign permit. r Permit # l'� Inspector fY / N Notes: ill there be any new construction or renovations? If so, obtain Uroter Permit Permit # Zoning to complete the following: 5.5 Violns: Y/jNf If so, is : Proffers: Y/N If so, List: Vari c: Y JW If so,mist: YIN so, List: i ` l If Cle r ces• ( SDP's TO A IL LLD Revised 11/1/2015 Page 3 of 3 FW 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 PA N TOPS P (-A`? A L L C the owner of record of Tax Map [name(s) of the record owners of the parcel] and Parcel Number manner identified below: Q Hand delivering a copy of the application to 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 Pei N d V PS P&A�e4, L L ( --- J LSEWH S 1W,50 < J [Name of the record owner if the record owner is a person; IV' i fi if the owner of record is an entity, identify the recipient of the record and the recipient's title or 1EH A 1 office for that entity] on Cf bj l In, , to the following address: Date [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 Print Applicant Name A/Z C 07 f C C: r S osh)1I Date 461 FROM ROAD SECOND FLOOR PARAMUS, NJ 07652 973.253.9393 T 973.253.9390 F WWW.SARGARCH.COM Company. County of Albemarle _ Address: 401 McIntire Road Charlottesville, vA 22902 Attn: Zoning Department - Amellia McCulley Phone: 434-296-5832 Q Plans ❑ Working Drawings ❑ Specifications ❑ Final Drawings ❑ Preliminary Dwgs. ❑ Shop Drawings TRANSMITTAL Via: Federal Express Date: 05/31 /16 Project # 160201-007 Project: Pet Valu Location: Charlottesville, VA Pantops Plaza - 2040 Abbey Road, Suite 103 ❑ Revised Drawings 0 Documents ❑ Other QUANTITY DRAWING DESCRIPTION DRAWING NUMBER DRAWING DATE H DATE OF ISSUE LATEST REVISION 1 copy Application for Zoning Clearance 05/31/16 3 sheets 1 co A-1.0 drawing Floor Plan 02/26/16 signed/sealed 1 check Zoning Clearance Fee - $54 05//31/16 Check #16932 ❑ As Requested For Coordination Purposes ❑ Approved As Submitted ❑� For Your Use For Your Information and/or Comments H Approved As Noted For Field Use For Approval and/or Correction Not Approved REMARKS: Amelia: Enclosed is the Zoning Clearance Application, floor plan, and check for the Zoning Clearance. Please let us know if you need anything else. Thanks, Nicole cc: Ellen Blakely BY: Nicole De Luca