HomeMy WebLinkAboutCLE201600206 Application 2016-09-14Application for Zoning Clearance
CLE # �D
OFFICE USE ONLY q /id
PLEASE REVIEW ALL 3 SHEETS Check# � Date:' `7IJ�
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel. — fj®f +� d�Existing Zonrii
Parcel Owner:
, -55 -
Parcel Address: 425 Merchant Walk Square
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project?
Address : -5z6-!5-
s-�? 4 7,7 veil #
Office Phone:
City Charolettesvft
uf3 M-z^`"
City
Fax # W I4- E-mail I Jti/
State VA
Zip 22902
APPLICANT INFORMA ILUi v
Check any that apply: Change of Ownership Change of use Change of name New business
Business NameJType: PetSmart, Inc_ / Specialty Pet Retail
Previous Business on this site NIA
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: S� t
*This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move the use to anew location, a new Zoning
Clearance will be required_
1 hereby certify that I o rthe owner's permission to use the space indicated on this application. I also certify that the information provided
is true and accurate of';my knowledge. I Have read the conditions of approval, ac�i-d�I understand totem, and that I will abide by them.
AfAw
Signature Printed `�J 4' 1W
APPROVAL INFORMATION
Approved as proposed [ ] Approved with conditions [ ]Denied
[ ] HackFlow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, xI17.
[ ] No physical site inspection has been done far this clearance. Therefore. it is not a determination of compliance with the existing
site plan.
[ j This site complies with the site plan as of this date.
Notes -
Building Official Date 1
Zoning Official 4 Date
Other Official Date
County of Albemarle Department of Commuuity 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:
Reviewer to complete the following:
�, ! ,
Square footage Of 'Use-'
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Q
N
Engineer's Report (CER) packet.
!
as: �`� J I
ermitted
Y I(N J
Y i ere be food preparation?
Under Section:
if so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from Health
Sapp leme>}tary regulations section:
Dept FAX DATE
Circle the one that applies
Parking formula: y�
rill
Is parcel on private well o ublic water'?
If private well, provide Hea artment forth.
Zoning review can not begin until we receive approval from Health
Required spaces: 6
Dept, FAX DATE
Y /
Circle the one that a
Items to be verified in the field:
is parcel on septic Kpublic sewer'?
YN
illIyou be putting up a new sign of any kind? if so, obtain proper
Sign permit
Inspector • Date:
Per rnit #
Notes:
N
ZIthere be any new construction or renovations?
in the roper Permit Q� 760
Permit # !✓
dZot��DZ�
Zoning to com lets the
Viola ons:
Yl
If so, List.
Varla e:
Y
If so, ist:
Clearances:
Proffers:
6/ N
If so, List:
CJ
Srs:
Yl(&
If so, List:
SDIP's
Revised 11.1112015 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 Deeterminadons or Appears, Sign Permits, Building Permits) if the application is not the
owner.
1 certify that notice of the application,
was provided to
ep,117Y Or A1ie�
[County application name and number]
the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number 0 7jr;M I `` OD 0"60 by delivering a copy of the application in the
manner identified below:
Q 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
PLIMailing 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 �/q 1 // 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].
Signaturef Applican�sri..{7`�
Print Applicant Name
Date