HomeMy WebLinkAboutCLE201800112 Approval - County 2018-07-24kPPROVED
' bemarle Counfir
Application for Zoo. ep [ ce
CLE #
OFFICE WE O LY
PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: Cry C9 oo -ok+` - 01 00V Existing Zoning
Parcel Owner: T:�L%,kyn L-L CL �J � j y r � C b, es
Parcel Address: 3 �{� �� , , , z,1 -e lr�: City QJ- `V, a, State V A. Zi? z� l
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? A-m Ci I �LC
Address CQ x, ,4 ►7 C i f? k City State V& Zip2 Z9 Ll
Office Phone: (_) Cell #434-eii,o-5'72(�ax # E-mail
filth, Vill
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: - 1�
Previous Business on this site
Describe the proposed business including use, number of employees numberof shifts, available parking spaces, number of
vehicles, and any additional information that you can provide: C4k'
*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 he best knowledge. I have
and accurate o of my read the conditions of approval, and I understand them, and that I will abide by them.
Signature -✓�/� Printed U n A, C S � fi( c(44-
PP VAL INFORMATION
[ !A proved as proposed [ ] Approved with conditions [ ] Denied
[ Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, x117.
[ ] 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:
Building Official Date %, /
AIL
Zoning Official Date C
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
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, 2 J a C I -r— & vzL-"
[County plication name and number]
was provided to f� V-- M ,L.y l the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number () q G 13 q .—OG - U, L-% [ 00.3 by delivering a copy of the application in the
manner identified below:
QHand 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
ailing a copy of the application to Otj Bn44
[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 5 b - 1-1 to the following address:
Date
[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 Applican
Print Applicant Name
Date
v
,Albemarle County
Planning Application
Community, Deli, elopmentDepartnierd
401 McIntire Road Charlottesville. b.422902-4596
Voice: (434)2%-5532 Fax (434)972-4126
TMF 046B4-00-00-01000 Dwner(s ): FERMIUM LLC
Application # ICLE2018001 12
PROPERTY INFORMATION
Legal Description FOREST LAKES OUT PARCEL 3 „
Magisterial Dist.:Rivanna + Land Use Primary Commercial
Current AM Not in A/F District Current Zoning Primary Planned Development Shopping Center
APPLICATION INFORMATION
Street .-'.ddress
I3445 SEMINOLE TRL CHARLOTTESVILLE, 22911
( Entered By
Application Type
Zoning Clearance
�
Judy rtin
Ma__
Project
Received Date
o-5 IOJ18
Received Date Final
Submittal Gate
Total Fees 54
Closing File Date
Submittal Date Final
Total Paid 54
Revision Number
Comments
Legal Ad
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T= Sub Lnnlie,atita Corni-nent
APPLICANT % CONTACT INFORMATION
ContactTypeName tr ss Ci State ii Phony PhorieCell
' •ar= ���=�'t FERh1IUM LLC 3002 BERKMA.R DRIVE ' CHARLOTTE.SVILL : 22901
966 C�,t•1PBELL RO.-D b,ES"ARCh,. 22947 4349605726 t,
LIND.r, C SHIFFLETT `
Signature of Contractor or Authorized ;gent Cate