HomeMy WebLinkAboutCLE201800012 Application 2018-01-19Application for, Zonin ClearanceA,
CLE # -
OFFICE USE O LY
PLEASE REVIEW ALL 3 SHEETS
Check # � Date:
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: 1010 0-0 0 -0 0 -0 5 6A0 Existing 'Zoning RA
Parcel Owner: Albemarle Co Schools
Parcel Address:4217 Red Hill Rd Citv Charlottesville State VA Zip 22903
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? Ruth Stornetta
Address: 307C 2nd St NW City Charlottesville State VA Zip 22902
Office Phone: (434) 982-3977 Cell # 434-242-3144 Fax # E-mail rs3j@virginia.edu
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: Monticello Velo Club/non-profit bicycle club
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:
Ric nle rant registration and parkin for hi a race on April 15, 2016
*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 -. ` >;1-Vv- ( Printed Ruth Stornetta
AP AROVAL INFORMATION
[1,11 Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] B9,aekflow 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 Official Date
Zoning Official Date
Other Official Date
,,.y V V111M ie Lepariment of k,ommunay 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
Is us m LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y
Will ere 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 on es
Is parcel o private well r public water?
If private we i e Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the on t applies
Is parcel o septic r public sewer?
Y/N
Will you be putting up a new sign of any kind?
Sign permit.
Permit# WOO (ejukit SOFA,
If so, obtain proper
Reviewer to complete the following:
Square footage of Use: A J h
P' / N 1
ermitted as: e m Vol E11. hen J` y
Under Section: ri d VYl I Y)1 S� � ol� Sy Q D 1.1 l 1(
Supplementary regulations section:
Parking formula:
Required spaces:
Y/N
It be verified in the field:
Fetm%t I Inspector:
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Notes:
Date:
Violations:
Y N
Ifs ist:
Proff
Y / N
If so, ist:
Variance:
Y
ist:
SP's:
Y�Ifs
If st:
Clearances:
SDP's
ZoIS"— °►
Z0Iu--Ir
i
-LoIL-3o
dli 19 Revised l l/1/2015 Page 3 of 3
z-
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, Zoning Clearance Application
[County application name and number]
was provided to Albemarle County Schools the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number 1010 0-0 0 -0 0 -0 5 6A0
manner identified below:
Hand delivering a copy of the application to
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 Kimberly Rhodes, Albemarle Co Public Schools I Departmg
[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 January 15, 2018 to the following address:
Date
2751 Hydraulic Road Charlottesville, VA 22901
[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].
_ 1
Signature of Applicant
Ruth Stornetta
Print Applicant Name
January 15, 2018
Date