HomeMy WebLinkAboutCLE201600275 Application 2016-12-19Application for Zoning Clearance
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PLEASE REVIEW ALL 3 SHEETS
Check # Date:'/
Receipt # I C/ L( Staff: '
PARCEL INFORMATION
Tax Map and Parcel: 045CO 03 OA 30000 Existing Zoning �--
Parcel Owner: Huynh & Zhu Property LLC
Parcel Address: 900 Gardens Blvd, unit 300 City Charlottesville State VA Zip 22901
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? Zobrist Law Group, PLLC, Attention: Annamarie Bonanno
Address : P.O. Box 4724 City Charlottesville State VA Zip 22905
Office Phone: 4( 34) 977.9664 Cell # 434.760.4668 Fax # 434.977.9664 E-mail Abonanno (*_)'Z,05 LALJ •CO/11
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name X New business
Business Name/Type: Patcha Thai Massage and Spa
Previous Business on this site Mercado World Market
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:
Thai Massage and Spa services, # of employees tbd, hours tbd., parking spaces 25+ shared with other businesses in
the shopping center.
*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 ac r t the best of wle_dge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed Patcharaporn Keomahathai
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, x 117.
[ ] 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 / Dates
Zoning Official Date /gLz-09
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:
Reviewer to complete the following:
Y / N I Square footage of Use: 1-10
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet. / N (�
ermitted as: M ji c.A
Y/N i
Will there be food preparation? Under Section: _� • 1-7 J
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from Health Supplementary regulations section:
Dept. FAX DATE
Circle the one that applies
Is parcel on private well " public wat
If private well, provide He ent form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applie
Is parcel on septic or u lic sew ?
Y/N
Will you be putting up a new sign of any kind?
Sign permit.
Permit #
If so, obtain proper
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
ZoninLj to complete the followiniz:
Parking formula:
v ZU4
Required spaces:
Y/
ItenVto be verified in the field:
Inspector:
Notes:
Date:
Violations:
Y/
If so, t:
Proffers:
Y/
If so', -List:
Var' nce:
Y/1(�V
If so, List:
SP's-
Y/1l
If so, st:
Clearances:
SDP's
Revised 11/1/2015 Page 3 of 3
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