HomeMy WebLinkAboutCLE201600152 Application 2017-02-16Application for Zoning Clearance
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check# Date: __l 111 I
Receipt # _1f1�13r5 Staff:
PARCEL INFORMATION
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Tax Map and Parcel: V (0,61 ( ( } 0 (`;�) � Q 0xisting Zoning f n Q S i J
Parcel Owner: S.J. Collins Enterprises 5 SW Broad Street, Suite B, PO Box 214 Fairburn, GA 30213 - (770)692-8300
Parcel Address: 435 Merchant Walk Square Suite 909 City Charlottesville State VA Zip 22902
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? Pranav Shah
Address • 2110 Arden Creek Way #6309 City Charlottesville State VA Zip 22901
Office Phone: (4341 242-0878 Cell # Fax # E-mail pranavinc@gmail.com
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: Fuzzy's Taco Shop - (Fast Casual Tex-Mex Restaurant)
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:
Fast casual restaurant employing 40 people working 3 shifts. I here will e 15 dedicatedparking spots and no
company vehicles.
*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 rate to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signatures V� Printed���
APDffOVAL INFORMATION
[ Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 9774511, 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
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 2%-5832 Fax: (434) 972-4126
Revised 11/02/2015 Page 2 of 3
Intake to complete the following:
Y /
Is use LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y/N
4ill there be food preparation?
If so, give applicant a Health Department form.
Zoning review can not gin until we eceive approval from Health
Dept. FAX DATE I I Iai
Circle the one that applies ptvVut
Is parcel on private well or public water.
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 or public sewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y,// N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit # - t-/c— 2-4 -7-7
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: 2
(Y)/ N t�
Permitted as:i'�iR/�l5%�j�rct
Under Section:
Supplementary regulations section:
Parking formula: 4 I 10
') J
Required spaces:
Y/N
Item be verified in the field:
Inspector : Date:
Notes:
Violations:
Y/N
If so, List:
offers:
Y/N
so, List:
Variance:
Y/N
If so, List:
is:
Y/N
so, List:
Clearances:
SDP's
Revised 11/1/2015 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 ih-
owner.
I certify that notice of the application,
[County application name and number]
was provided to the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number by delivering a copy of the application in the
manner identified below:
= 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]
m
Date
✓= Mailing a copy of the application to S.J. Collins Enterprises
[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 7/6/2016 to the following address:
Date
Post Office Box 214 Fairburn, GA 30213
[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
Pranav Shah
Print Applicant Name
7/6/2016
Date