HomeMy WebLinkAboutCLE201600073 Application 2017-04-21Application for Zonin Clearance
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CLE# 2t� to-7
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OFFICE USE LY e_imU :51 i Ni
PLEASE REVIEW ALL 3 SHEETS
Check # U Date:
Receipt # Staff:
PARCEL INFORMATION f rp , 1
D� f� o Existing Zoning � `1 S
Tax Map and Parcel: Q`7 �g��p p-Duo,
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ParcelOwner:
1
Parcel Address: iU-1gj e6ll hI 01 &i'LJP. City C `y11 fie. State VA- Zip z2'g11
(include suite or floor)
PRIMARY CONTACT
Who should we call/writeconcerniin, g this project? 'i/11 L7 }',— owivig
Address : �) � &"1 1tj 1'l � 1 je/ rCity 1111 If-/ State VA —Zip a?igl l
Office Phone4c3q' Cell # 025 117 � Fax # E-mail AR,04 Yl-6Ytg c)(41 Dae—
APPLICANTT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: �1n�D 0A DLtA�-h 1 ol')
Previous Business on this site _ _ _ r Gil
Describe the proposed business including use, number of employees number of shifts, available parking spaces, number of
information R("J S
vehicles, and any additional that you can provide: I b� 2,'D 1
*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 the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature '-----' Printed &zt
J on
APPROVAL INFORMATION
[VApproved as proposed [ ] Approved with conditions [ j Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, xl l7.
[ ] 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 c p ' s with the site plan as of this e. ,"'t
Notes: OLE(�'
Building Official 4 �— Date
Zoning Official Date /
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 7/l/2011 Page 2 of
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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,
t [County application name and number]
was provided to (i lY, s MM14 , the owner of record of Tax Map
[name(s) of the record owners of the rcel]
and Parcel Number 0� (0 OD ;A ' i7p (►10 by delivering a copy of the application in the
manner identified below:
`�' Hand delivering a copy of the application to K Yy1, Cj f ar- , P 'Q o rd
[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 i 15
Date
Mailing 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'stitle or
office for that entity]
on
Date
to the following address:
[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].
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APPROVAL DATE
Virginia Department
VD0 - f Trrnsporiatior,
LAND USE PERMIT
LUP-SEA
Special Event Approvals
August 26, 2014
COUNTY ADMINISTRATOR /
Remarks:
_March 23, 2016 _ACPD Sgt M Stoddard
APPROVAL DATE LOCAL LAW ENFORCEMENT AGENCY
OR DESIGNEE
Remarks: The Albemarle County Police Department is in approval of the Dogwood Duathlon that will take place on
April 24, 2016. I, Sergeant Stoddard, have reviewed the race course and spoken with the race organizers. The race
will be staffed with contractual officers at various posts along the route. This event does not create any public or
traffic safety concerns.
APPROVAL DATE VIRGINIA STATE POLICE (Sergeant/Area/Division)
Remarks:
APPROVAL DATE
VDOT REPRESENTATIVE
Remarks (include any changes that may be made by VDOT):
Cc: County/Town Administration
Local Law Enforcement
Virginia State Police
VDOT Residency Office / Maintenance AHQ