HomeMy WebLinkAboutCLE201700276 Application 2017-12-08Application for Zoning Clearance
CLE #
.. itRGIN�P
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # b Date: I a
Receipt #9Ug5j7j Staff:
PARCEL INFORMATION � I � tj 3<z
Tax Map and Parcel: 06100-00-00-13100 Existing Zoning P p S Iw
Parcel Owner: Fashion Square Mall LLC
Parcel Address:1600 Rio Road East _ City Charlottesville State VA Zip 22901
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? Bonnie Brown
Address :1210 Stewartsville Rd City Bedford State Va Zip 24523
Office Phone: Cell # 540 330 8995 Fax # E-mail basketsbybonnie@hotmail.com
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name x New business
Business Name/Type: 2 day Vendor Event
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:
about 20 table vendors
*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 Bonnie Brown
APPROVAL INFORMATION
[ t/j Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] B flow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, x117.
[ 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 OfficialDate
Zoning Official 4AW Date '6 / I f/
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 11/02/2015 Page 2 of 3
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 ublic water?
If private well, provide Healt epartment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that ap
Is parcel on septic r public sewer?
Y Wil u /1`Yo
be putting up a new sign of any kind?
Sign permit.
Permit #
Reviewer to complete the following:
Square footage of Use: ZOO El
F'eimitted as: Q V
Under Section: p; G yin 1 y�, )
Supplementary regulations section:
Parking formula:
14.7� hori ,
Required spaces: f
Y rl�g Ite be verified in the field:
If so, obtain proper
Inspector : Date:
Y / N Notes:
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the followin :
Violations:
Y/N
If so, List:
Q(��G���
Pro
Y/N
If st:
VaCN
riae:
YY
If1st:
SP's:
N
o, List.
19S2 Sb
Clearances:
SDP's
Zone— 37
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 the
owner.
I certify that notice of the application,
was provided to
[County application name and number]
[name(s) of the record owners of the parcel]
and Parcel Number 06100-00-00-13100
manner identified below:
Hand delivering a copy of the application to
the owner of record of Tax Map
by delivering a copy of the application in the
[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
[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:
[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
Bonnie Brown
Print Applicant Name
December 4, 2017
Date
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