HomeMy WebLinkAboutCLE201600181 Application 2016-09-02Application for Zofn 1W Clearance��Af�,�
CLE # C206
OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS Check # //3/ Date:
Receipt # !D S laYt-I 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
Office Phone: 4f 34) 531-2434 Cell # 434-531-24Y"IFax # 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: Vanda Lea LLC
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:
-Hair Stylist & Make-up Artist, 1 Employee, 1 Shift, 48 Available Parking Spaces, & No Company Vehin-le
*'I9)is 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 o or have the permission to /usee space indicated on this application. I also certify that the infom�ation provided
is true and accurate tc, best of m o e. I have readnditions of approval,
a��nd�� I understand them, and that I will abide by them.
��zSignature Printed IA -, ► L "&xG—
APPROVAL INFORMATION
[ ] Approved as proposed [ ] Approved with conditions j ] Denied
[ ] Back -flow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, x117.
j ] 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
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:
Y/N0
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
n.
Y /V
Will 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
Circle the one that applies
Is parcel on private well o ublic wat
If private well, provide H rtment 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 lie sew
Y / ;6
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit ##
Yl
Will 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: (60-
Qr:tted
as: be"1
Under Section: , P
iJ
Supplementary regulations section:
Parking formula: 'ba 4�,PA
Required spaces:
YIN v
Items to be verified in the field:
Violations:
YIN
If so, List:
Proffers:
Y/N
If so, List:
Variance:
YIN
If so, List.
SP's:
Y/N
If so, List:
Clearances:
SDP's
Revised H/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-0 1 -OA-009AO 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 current real estate tax assessment records satisfies
this requirement]. 1x-**2Y
gnature o pplicant
Sue A. Albrecht
Print Applicant Name
6
Date