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Home My WebLink AboutCLE201600231 Application 2016-10-103(,fo95.9 Application for Zoning Clearance �_ CLE # C2U& -r931 OFFICE USE ONLY PLEASE REVIEW ALL 3 SHEETS Check # Date: Receipt # staff• PARCEL INFORMATION Tax Map and Parcel: Existing Zoning Parcel Owner: Greenbriar Real Property LLC, 200 Carton Road, Charlottesville, VA 22902 Parcel Address: 1245 Seminole Trail City Charlottesville State VA Zip 22901 (include suite or floor) PRIMARY CONTACT Who should we call/write concerning this project? Remod Katuwal Address: 9700 Lomond Drive City Manassas State VA Zip 20109 Office Phone: (703) 981-3684 Cell # Fax # _ A)/A E-mail remodcat@gmail.com APPLICANT INFORMATION Check any that apply: X Change of ownership Change of use Change of name New business Business Namerfype: retail convenience Previous Business on this site 7-Eleven 36085H Describe the proposed business including use, number of employees, number of shifts, available perking spaces, number of vehicles asp any additional information that you can provide: IrF—+a�.i coht/F I 1 £ rn i0 � 3 5 parlan c stets , 3a 0 sQ �f ,, u e e Es - *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 best my kn edge. I have read the conditions of approval, and I understand them, and that I will abide by them. Signature Printed Remod Katuwal APPROVAL INFORMATION Ix Approved as proposed f ] 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 ao 6 %( 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 N Is use n LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. YIN 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 ic wa e 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 o ublic sewe Y/(2 Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Y 1 WiII ffiere 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: `3 O j Y)/ N Permitted as: i Under Section: �? Supplementary regulations section: Parking formula: %o Required spaces: YI Items to be verified in the field: Inspector : Date: Notes: Vio tions: Y/ If so, st: Proffers: Y If so, List: Vari ce: Y/ If so, List: SP's: Y If so, List: Clearances: SDP's Revised 11/I/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, &PIf`Cd-,L0Ion h/ 20t n Q atta rc(145 [County application name and umber] was provided to Greenbriar Real Property LLC the owner of record of Tax Map [name(s) of the record owners of the parcel] and Parcel Number 6(,t10 --ov -0d '0d36o 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 0 Mailing a copy of the application to Greenbriar Real Property LLC -11 U0 S O/I i ft tlaggr/!itm Ay [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 PO Box 1607, Charlottesville, VA 22901 [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 Appli4nt Remod Katuwa! Print Applicant Name 9/16/2016 Date Exhibit B prcmises/M,otor rucl,. Facility/Common Area plot plan COUMOU r PV. "2 Art Car ash zz AM A c4n JW Luba W. t di to 4 Ab a all Moor Feeb Ares L Or Csis fit 7e. . gj mn -a.— 3.59A6 \P t case AglacTnerl . Exhibit B 1429S()52v 5,135()454W977 aDuuuas.ue r 10 0 -ca-w Agreement -- Page 25 14295052r.S / 35043-M977 AMELIA LICENSING, LLC 11518 Cedar Lane a Ashland a Virginia 23005 804-368-0612 offiicelfax September 16, 2016 RE: Power of Attorney for Katuwal Enterprises Inc. To Whom It May Concern: I, Remod Katuwal, President of SNIP Inc., hereby authorize Caryl Purcell, Ronald Maupin, and/or Neal Seay to act on my behalf to apply for, certify, obtain, or perform other processes to acquire all required licenses for my business, 7-Eleven 36085A, located at 1245 Seminole Trail, Charlottesville, VA 22901. This authorization is effective as of the date of this letter and will be void after June 30, 2018. By: Name: Title: Commonwealth of Virginia City of Richmond Subscribed and sworn to (or affirmed) before me this 16_ day of September , 2016, by Remod Katuwal, personally known to me or proved to me in the basis of satisfactory evidence to be the person who appeared before me. Khaled Khashroom Stamp Signature of Notary My commission expires on July 31, 2018 Registration Number 7591230