HomeMy WebLinkAboutCLE201800176 Approval - County 2018-09-11APPROVE[
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pp on,� jo rance
ICLE # (� - 1
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PLEASE REVIEW ALL 3 SHEETS
OFFICE U§E ONLY c
Check # z Date:
Receipt # Staff:
PARCEL INFORMATION
Tax Map Parcel: 0 0 - CO 2 U O
and QO — Existing Zoning
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Parcel Owner: So (�, �D LL �
Irv/LQf
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Parcel Address: ' (o`i ` ��, a IQ Tr City C State
(include suite or floor)
PRIMARY CONTACT
Who
should we call/write concerning this project? _(5� Cal (C (J
896 King William Dr Charlottesville VA
Address : City State Zip 22901
Office Phone: (_) Cell # 703-973-2702 Fax # E-mail brent(a7,,,graciecharlottesville.com
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name _New business
Business Name/Type: Open Mat, Inc. (DBA Gracie Charlottesville) Ca (ez Jo �hkc o
Previous Business on this site 5 J IV—,. _ r W n S A I �c� J
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: Jiu-Jitsu Self -Defense Academy (including wrestling),
1 official employee, 5 owners Parking will be needed from 330pm-9.30pm but we will start with no members and grow
slowly, We have one company vehicle a stretch limo that will be in cking kids up from school Call rn W for more info,
*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 my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
�b�esttoof
Signature bCA Printed Brent Lillard
APYRGVAL INFORMATION
Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-451 1, x 117.
[ ] 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 f��0/�d
Zoning Official 4 Date J I r
IV
Other Official Date
t_ounty of Ainemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
Revised 1 1 /02/2015 Page 2 of 3
Intake to complete the following:
Y /�
Is use m LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y / JO
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 or ublic 7a r?
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that =610�s(4er?
Is parcel on septic
Y J N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit # b � 10,13
Y /(N )
ill there be any new construction or renovations?
If so, obtain the proper Permit.
Permit # --6(AUIO / 05t)
Zoning to complete the following:
Violations:
Y/N
If so, List:
Variance:
Y/N
If so. List:
Clearances:
Reviewer to complete the following:
Square footage of Use: 4 ► I!'
Wot(ermned as: '► I~�
Under Section:
Supplementary regulations section:
Parking formula:
Required spacesniq
•�
Y f N
Ite o be verified in the field:
Inspector : Date: _
Notes:
Proffers: J
/ N If so,
List:
SP's:
Y/N
If so, List:
SDP's
Revised 11/ 1 /2015 Page 3 of 3
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