HomeMy WebLinkAboutCLE201800081 Approval - County 2018-05-114
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l"4aarre County
ipnt nenwnrttrer
Application for Zoning Clearance
CLE # 7 2 ri<,- `_
OFFICE USE ONLY
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PLEASE REVIEW ALL 3 SHEETS Check# Date: [ A l
Receipt # ff:
PARCEL INFORMATION
Tax Map and Parcel: 04500-00-00-11000 Existing Zoning k C
Parcel Owner: First Gold Leaf Land Trust
Parcel Address: 431 Gander Drive City Charlottesville State VA
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(include suite or floor)
PRIMARY CONTACT V i ^J c�,�H q
Who
should we calUwrite concerning this project.
Address: —7 g� tN - 13 iz-61,% S i S i"e 1 City f+fyy z4 Ga State Zip Z 3 2 `� IJ
Office Phone: (7(>% 7 (-9 - 910, Cell # F'"t gu 7 - 418ax # '�`f (v'7 Z - —t`t s'o L oryH r�.H
E-mail 1 b 13r'..LLr-_tiot-bi-v& 1
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APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name x New business
BusinessName/Type: out FALoyylL.6 rZSs-rAwzo 1
Previous Business on this site N l pr
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: _ F::j STAyR-A"J i 'i S ErAPLoy EIS
t'
O G�'�PA Nit Vc.t.N CLir"S
'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 hcrcby cerlyor have the o ess pctmission to use the space indicated on this application. I also certify that the information provided
istrueand!,0own
the best of my kno edge. i have read the conditions of approval. and I understand them, and that I will abide by them.
Signature Printed
APPRWAL INFORMATION--'
( ] roved as proposed ( J Approved with conditions { J Denied
( ackflow prevention device and/or current test data needed for this site. Contact ACSA, 9774511, xi 17.
[ ) 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:
13tuUduxg Offidal Date L41 Iq I,
C
Zoning Official Dates )I
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 9724126
Revised l 1 /02/2015 Page 2 of 3
VC.
M
Intake to complete the following:
Y/N
Is S)LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/N
ill there be food preparation?
If so, give applicant a Health Department form.
Zoning review can not begin until ceiv� i pr�val from Health
Dept. FAX DATE Ol-' fib/
Circle the one that applies
Is parcel on private well o public water?
If private well, provide H It Departme orm.
Zoning review can not beg unti we receive approval from Health
Dept. FAX DATE
Circle the one that appli
Is parcel on septic or ublic sewe .
Y UN
'Will you be putting up a new sign of any kind? If so, obtain proper
Sign perm . t. r
Permit #
Y,Y N
ill there be any new construction or renovations?
If so, obtain the proper Permit.
Permit # IJVA V I I 1 ��k S
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use:
(DN
fitted as:
Under Section:
Supplementary regulations section:
Parking formula: I J
I
Required spaces: I
Y/N
Item e verified in the field:
Inspector:
Notes:
QJ
Date:
Viol ns:
if
If st:
s
Pro rs.
Y/N
Ifs 'st:
Variance:
Y/N
If so, List:
SP's-
y/
If s Ist:
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 toning 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,
[County application name and number]
was provided to First Gold Leaf Land Trust the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number 04500-00-00-11000 by delivering a copy of the application in the
manner identified below:
® Band 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]
on
Date
Mailing a copy of the application to Nena Harrell, Vice President, United Land Corporation
[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 23, 2018 to the following address:
Bate
[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].
S gnature of Applicant
Print Applicant Name
1�23�1�
Date