HomeMy WebLinkAboutCLE201900273 Application 2020-03-271-25-19;12;25PM;
;5409436676 # 4/ 5
Application for Zoning Clearance
PLEASE REVIEW ALL 3 SHEETS
OFFICE U E ONLY
Check # Date: 11Z ,r//
Receipt M Sin:
PARCEL INFORMATION
p C
Tax Map and Parcel: 78-17D6 Existing Zoning T ` J C
Parcel Owner: Woodward Properties
Parcel Address: 260 S. Pantops Drive City Charlottesville State VA Gip 22911
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? Scott Lancey
Address :801 Hopeman Pkwy City Waynesboro State VA Zip 22980
Office Phone: (540) 943-6675 Cell # 540-461-2171 Fax # 540-943-6676 E-mail soott.Wnwy@scouting.org
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of naMee New business
Business No Boy Scouts of America/Non-Profit Youth Organizatlon
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-
' ` ` ' nd racks, zoFo employees,-10 9 a vW, inteers
'This Clearance will only be valid on the parcel for which it is approved Ifyou change, intensify or move the LL;e 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 indicntcd 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 ol'approval, and 1 understand them, and that 1 will abide by them,
Signature Printed Scott M. Lancey
APPROVAL INFORMATION
[ ] Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511. 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 l�
S
ffiC
Zoning Ocial Date 6 2 `" 2-7`1 C%
Other Official Date
t-ounty of Amemarte uepartment 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
11-25-19;12;25PM;
;5409436676 # 5/ 5
Intake to complete the following:
Y l i�
Is u3�in Ll, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y
Wilre be food preparation?
If so, give applicant a Health Department form.
Zoning rcvicw can not begin until we receive approval from Health
Dept, FAX DATE
Circle the one that applies
is parcel on privnte well'or public water
If private well, provide Health 96par7trtiem term.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that ap
Is parcel on septic qrip is 9ewer'3�
Y/N
Will you be putting up a new sign of any kind? if so, obtain proper
Sign permit.
Permit 0
Y �..
Will tKere be any new construction or renovations?
If so. obtain the proper Permit.
Permit ft
Zoning to complete the followine:
Reviewer to complete the following:
Square footage of Use;
itrmi tted as: /" YJ I ' ! (r-s
Under Scetion: _�G% u,4 I &G ,. ,
Supplementary regulations section;
Parking formula: 1
4 /�
Required spaces; Q Q
Y/N
Items to be verified in the field:
inspector:
Notes:
Vio ffi0ps:
Y i
ifs�a,'[.ist:
�,r
� o�
_
� t g5 Ito
roffcr�:
Y a`
soz List:
b� 2PS 3 3 LO t
Variance:p
%T N
so, List:
j� ``
n {
1V
fso, List;
Clcnranccs:
SDP's
-
sP
Revised I l /1 /201 S Page 3 of 3
CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
This form must accompany zoning applit.•ations (Hone 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 4,-s- Tk
U-Ezotq- 2-73
[County application name and number]
Lname(s) of the record owners of the parcel]
and Parc 1 N b % C9 1-7 � I —
the owner of record of Tax Map
e um er by delivering a copy of the application in the
manner identified below:
Hand delivering a copy of the application to
[Name of the record owner if the record owner is a
Per -son; 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 f� } i"
[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 -2,' 1 to the following address:
Date
-I-Al4gA l A �✓ lstx�l�u�A2�j�irJ 1 � �S
[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
S)t&QAL--L this requirement].
4
�T.aso
F P-111 i
Mi�b vcPa-S
�1
Signature of Applicant
SQD-rr
Print Applicant Name
1 c —�C 1C1
Date