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Home My WebLink AboutCLE201600055 Application 2017-01-10Application for Zoning Clearance CLE # 2016 — 5 OFFICE USE QNJY_ PLEASE REVIEW ALL 3 SHEETS Cheek# Dates Receipt # Staff: PARCEL INFORMATION _ t "'q6 U Existing Zonin I� Tax Map and Parcel: Parcel Owner: YIN hf..11301 c 'r Parcel Address: WO/ or�1` CST ,/, 4W' y city Clrq�(o>+/rS�i%�J State VA Zip 22% (include suite or floor) , PRIMARY CONTACT Who should we call/write concerning this project? Address: SZ%y �jl!// C� c City Gl, State VA -- ZI pZ z 5� Office Phone: (;L3fj 2C16- S, 20 Cell # Fax # E-mail /wh4gS( /O zo rtfcr� p� APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business Business Namellype: 33✓ �flr/ycz% Jc, r cC �c try) /t f I r 7 Previous Business on this site 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: _ � e4 4 �� *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 th best of y 1 ge. I have read the conditions of approval, and I understand them, and that I/will abide by them. Signature Printed /�Vci /-/"hC'w APPPWVAL INFORMATION [Lj4pproved as proposed f j Approved with conditions [ ] Denied [ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, xl 17. [ ] 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 comp�liq with the site pl as ofthis tee. �h,,,� y�� Notes: b�l U CIJI 1-—(--YOt'� I i Building Official Date Zoning Official Date G� 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/l/2015 Page 2 of 3 Kiwanis, Charlottesville New Catws&St-a4tkatSut�herla. Mid I&Schot). w 33nd Annual -�r* r W INDEPENDENCE DAY 5K RUN WHEN: Monday, July 4, 2016, at 7:30 a.m. WHERE: Forest Lakes Subdivision: Sutherland Middle School Sponsored by BETTER and Hosted by Kiwanis Club of Charlottesville and Charlottesville Track Club LIVING 1. To Benefit Camp Holiday Trails Over $125,000 has been donated to this charity over the years/ ------------------ REGISTRATIONINFORMATION------------------ Fee: $25 CTC members, $26 non-CTC members, $20 Students, $30 all race day entries Please make checks payable to: Kiwanis Club of Charlottesville 4 Ways to Register: By Mail, prior to June 30: Kiwanis Club, 925 Dorchester Place #303, Charlottesville, VA 22911 Hand -Deliver, by 5 p.m. on July 2: Ragged Mountain Running Shop Online: http://charlottesvilletrackciub.org In -Person on Race Day, 6:30 a.m.: Sutherland Middle School Cafeteria, 2801 Powell Creek Drive Award categories for all age groups, including the youngsters (10 & younger)! "My 4th of July experience has been enriched over the years, thanks to this wonderful community event. " — Mark Lorenzoni For more information, call: 434.293.3367 (daytime, Mon -Fri) or 434.244.2909 (evenings) Last Name: First Name: Address: State: Zip: Daytime Phone: City: Email (optional): Age on Race Day: Sex: M F T-Shirt Size: Child S M L XL 2XL CTC Member: Y N LIABILITY WAIVER MUST BE SIGNED I know that running a road race is a potentially hazardous activity. I should not enter and run unless I am medically able and properly trained. I agree to abide by all decisions of the race officials relative to my ability to complete the run safely. I assume all risks associated with running in this event, including, but not limited to, falls, contact with other participants, the effects of weather, including high heat and humidity, traffic and the conditions of the road, all such risks being known and appreciated by me. Having read this waiver and knowing these facts and in consideration of your accepting my entry, I, for myself and anyone entitled to act on my behalf, waive and release the Kiwanis Club of Charlottesville, the Charlottesville Track Club, Forest Lakes Community Association, the County of Albemarle, all beneficiaries, and all sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in this event. Furthermore, I agree to be bound by the rules established with respect to this event. In consideration of the safety of all participants, I understand that absolutely no baby joggers, baby strollers, headphones, animals on leash, skateboard, skates, roller blades or bicycles are allowed on the course. In addition, I understand that if the race is canceled by circumstances beyond the control of the organizers, my entry fee will not be refunded. SIGNATURE (Parent or Guardian, if under 18): Date: Hollymead Elementary School to 2775 Powell Creek Dr, Charlottesville, VA 22911 - Go... Page 1 of 1 .�3 2775 Powell Mseek Dry '*t! a Townhanea ' n k `k �Y"` Morinc Y. 9uthedmM �t..� t 0 °Mwfi.9choolrN ob M �°",..-Burring0rA�tr f y'._;. i uiyi�l� f �y SkI f.' ,•}�$ R r£�'�` 'f is `` y; •x t r. ,ti F 'i� s.4{' „'�*'�r4.• a � wl ; `�` �Y .` r�x ��Fx'"Y�3- '�.� �j",� t r.r,��', '� ;�� `r ;. 3 ` �. z. k- .t, t k. •g�jrs � fx �• � s'c � �` * '� �lx � ; '}.. Evngean C�hrech-,i, _ e e �� y, Y ,:1° ,�, �'`£ad��`} y�� ` � �� s` fudonGaylory • t, i <} i � ��; tt � k "'r � � t� _�� t f v`� �1 � d r�as'C. �'�, �� `+'�! � y t � �•k eq+�'� ri* J r. :• .�ra'v�Ysea"� Sk'd. ��` "._.. �r"fi.A' r• s t',- v Je �r ��y. �.. � a .. file:///C:/Users/egomezlAppData/LocallMicrosoftlWindowsITemporary%20Internet%20Fi... 7/ 10/2015