HomeMy WebLinkAboutCLE201700028 Application 2017-04-12Application for Zoning Clearance0
OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS
Check # IR Date: Z-
Receipt # Staff: 35,
PARCEL INFORMATION
_ f� I r1.
Tax Map and Parcel: �21� - G2— V, Existing Zoning l 4 wCwWJQ_4
Parcel Owner: Pura Vida Rising, LLC
Parcel Address: 2399 Leake Square City Charlottesville State VA Zip 22911
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? Warren Aldrich
Address: 11752 Chanceford Dr City Woodbridge State VA zips
Office Phone: Cell # 571-436-3612 Fax # E-mail con i
APPLICANT INFORMATION
Check any that apply: Change of ownership x Change of use Change of name New business
Business Name/Type: Store -It -Right, LLC
Previous Business on this site Leisure Landscapes, Inc
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: Self Storage, 2 employees, 4 pkg + unlimited loading
No 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 ow or have the ow�n�er's permission to use the space indicated on this application. I also certify, that the information provided
is true and accurate to best of my krl6wledge. I haread the conditions of approval, and I understand them, and that I will abide by them.
Signature �� i is G�i Printed_ (/y im' RAJ
APPROVAL INFORMATION
[ LJ, proved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, xl 17.
[ — o 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 (I i
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
3�1 0 � Revised 11 /02/2015 Page 2 of 3
a b 22l0 )ice l-4
Intake to complete the following: Reviewer to complete the following:
Y N ,J Square footage of Use: 5H
Is u`secin Ll, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet. Y / N
Permitted as:
Y/N`j,
Wil e be food preparation? Under Section:
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 Parking formula:
Is parcel on private we l or public w el
If private well, provide alt artment form.
Zoning review can not begin until we receive approval from Health Required spaces:
Dept. FAX DATE
Y/N
Circle the one that applies Items to be verified in the field:
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 # , Inspector : Date:
Y / N Notes:
Will there be any new con�ion or renovations?
If so, obtain the proper Permit.
Permit #
Zonine to comDlete the followinu:
iolations:
4Y N
so, List:
Proffers:
/N
so, List:
Variance:
(�/ N
If so, List:
N
If so, List:
Clearances:
SDP's
Revised I I/l/2015 Page 3 of
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