HomeMy WebLinkAboutCLE201600182 Application 2016-09-02Application for Z,,onin Clearance 0CLE
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OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS Check # 1130 Date:
Receipt # /� Staff: 5 ,
PARCEL INFORMATION
Tax Map and Parcel: 061 WO-01-OA-009AO Existing Zoning C-1
Parcel Owner: Sue A. Albrecht
Parcel Address: 2300 Commonwealth Drive City Charlottesville State VA Zip 22901
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? Sue A. Albrecht
Address: 255 Ipswich Place City Charlottesville State VA Zip 22901
Office Phone: (434) 531-243" Cell# 434-531-24 Fax# 434-973-0732 E-man sue@designenvirons.com
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name X New business
Business Name/Type: Cynthia Jeanne Frey DBA Treat Yourself Right
Previous Business on this site Rimm Kaufman
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:
-Massages, 1 Masseuse, 4 Shift, 48 Available ParklAg Spares & No Company Vehicia
*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, anew Zoning
Clearance will be required.
I hereby certify that I own or have the own 'permission to u I space indicated on this application. I also certify that the information provided
is true�'�tthe best of 1 a le ge. I have read conditions of approval, and I understand them, and that twill abide by them.
SignatPrinted V 4 L
APP VAL INFORMATION
[tApproved 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 Official Date W,
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 11/02/2015 Page 2 of 3
Intake to complete the following:
Yl
Is us n LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Yl
Will ere 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 p lic er?
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 pu c se r?
Y
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/
Will re be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: % 0
Ye N
Se -Knitted as:
Under Section: (56
Supplementary regulations section:
Parking formula: f y�
1
Required spaces:
Y N
It be verified in the field:
Inspector :
Notes:
Violations:
YIN
If so, List:
Proffers:
YIN
If so, List:
Variance:
YIN
If so, List:
SP's:
YIN
If so, List:
Clearances:
SDP's
Revised 11/1/2015 Page 3 of
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, Sue A. Albrecht
[County application name and number]
was provided to Sue A. Albrecht the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number 061 WO-01-OA-009A0 by delivering a copy of the application in the
manner identified below:
Hand delivering a copy of the application to Commonwealth Business Center
[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
[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 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
this requirement].
Sue A. Albrecht
Print Applicant Name
101i
Date
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