HomeMy WebLinkAboutCLE201700004 Application 2017-01-10Application for Zoning Clearance
CLE # 2()V— Li
OFFICE USE ,ONLY
PLEASE REVIEW ALL 3 SHEETS Check #
Receipt #
PARCEL INFORMATION
Tax Map and Parcel: 76 11-2
Parcel Owner: SJ Collins Enterprises, LLC
Date: _460�
Staff:
Existing Zoning Commercial
Parcel Address:150 Wegman's Way City Charlottesville
(include suite or floor)
PRIMARY CONTACT
Who should we calt/write concerning this project? William L.
Address : 2302 Colonial Ave., Ste. F
Office Phone: 5( 40) 400-7684 Cell #
APPLICANT INFORMATION
Check anv that apply: Change of ownersh
Business Name/Type: health/fitness club
Previous Business on this site none
State VA
III or Christa Woomer
City Roanoke
State VA
Zip 22902
Zip 24015
Fax # E-mail christa@asbellplanet.com
of use _Change of name x New business
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:
*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 owners permission to use the space indicated on this application. I also certify that the information provided
is true and accurate to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature / 4M „. zvezi;�4 Printed William L. Asbell, III
APPROVAL INFORMATION
Approved as propose;, .., . __4( ].Approved with conditions [ ]Denied
Backflow preo�hon evice 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
Date //a /Zoi7
Zoning Official —I
Other Official Date
County of AIDemarne lieparauroui v■ t vn,u■uu■, J �... �- y---�---
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
Revised 11/02/2015 Page 2 of
Intake to complete the following:
Y/N
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/N
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 or �Depaert
?
If private well, provide Health form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that appl'
Is parcel on septic o ublic sew ?
V / N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
/ N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit �- 015 —f 2sC l)L/
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use:
6)/N
Permitted as: 1iJ,, -,'
Under Section: Z �-L- .
Supplementary regulations section:
Parking formula: q.,
/JUa
Required spaces:
Y/N
Items to be verified in the field:
Inspector:
Notes:
Date:
Violations:
Y /
If so, ist:
Proffers:
O/ N
If so, List: 4
of — l
Varia ce:
Y/V
If so, List:
SP's
Y/
If so, List:
Clearances:
SDP's
Revised 11/l/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.
1 certify that notice of the application, Albemarle County Zoning Clearance
[County application name and number]
was provided to SJ Collins Enterprises, LLC the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number -76ff) 1- O) 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
Mailing a copy of the application to Alex Smith, Real Estate Manager
[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
to the following address:
PO Box 6230, Orlando, FL 32802
[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 Applicant
William L. Asbell, III
Print Applicant Name
1 /4/17
Date
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