HomeMy WebLinkAboutCLE201600179 Application 2016-09-02Application for Zoning Clearances"�
CLE # _6�
OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS Check # J gpl Date:
Receipt # 4:N'7 4 V ,6- Staff:
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
t'
Office Phone: �) 531-243 Cell # 434-531-243& Fax # 434-973-0732 E-mail sue@designenvirons.Com
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name X New business
Business Name/Type: Massage by Lisa Wood
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:
-Massage Therapist, 1 Masseuse, 1 Shift, 48—Ava-01-a-ble- Parking Spacer, & No Cgmpapy VehiGis
'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 thylw<1 or haJkw'ledge.
s permission to use the space indicated on this application. I also certify that the information pravided
is true and accurahe best I h e read the conditions of approval, and I understand them, and that I will abide by them,
Si Printed- SUS: A- ALL�F'C�� _
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, 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 1, Date
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax. (434) 972-41126
Revised 11/02/2015 Page 2 of 3
Intake to complete the following:
Y INN Is u n LI, Hl or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y f N J
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 ab is wat
If private well, provide Hea fitment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that appli
Is parcel on septic or ublic sewe .
Y /T
Wil ou be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Yl
Wil ere 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:
N r/mitted as: �,6
Cinder Section:
Supplementary regulations section:
Parking formula: 1 f da 116 f— l
Required spaces: J 1
YIN
Items to be verified in the field:
Inspector: Date:
Notes:
Violations:
Y/N
If so, List:
Proffers:
YIN
If so, List:
Variance:
Y/N
If so, List:
SP's:
YIN
If so, List:
Clearances:
SDP's
Revised I I/1/2015 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, 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
man r identified below:
by delivering a copy of the application in the
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
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].
Signature of Applicant
Sue A. Albrecht
Print Applicant Name
B- Y114
Date
mR
C
PROJECT NAME: DESIGN ENVIRONS GORPORATION REVISJON5:
Q2300 COMMONWEALTH DESIGNED . BUILT • FURNISHED . INSTALLED DATE: BY:
o SUITE 101—A
DRAWN BY: CHRISTEN FORTAIULEER wne,xa�n erv� swawm®oesir�e+mnous.owa cuss •n•cav,w'cron esroso,auw
EXHIBIT A
SATE: 07I20/2016 SCALE: 1 /4' = IT 340 GREEENBRIER ORJVE CHARLOTTESVILLE. VIRGINIA 22901