HomeMy WebLinkAboutCLE201900274 Application 2020-03-271-25-19;12:51PM;
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Application for Zoning Clearance
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CLC #
OFFICE US NLY /
12
PLEASE REVIEWS ALL 3 SHEETS
Check# Drte:l
Receipt # Staff:
PARCEL INFORMATION i J
45-111-A Existing Zoning `_t
Tax Map and Parcel:
Parcel Owner: Planters Bank & Trust (Atlantic Union Bank)
Parcel Address: 410 Gander Dr City Charlottesville State VA Lip 22901
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? Scott Lancey
Address :810 Hopeman Pkwy City Waynesboro State VA Zip 22980
Office Phone: 5( 40) 943-6675 Cell # 540-461-2171 Fax # 540-943-6676 E-mail scott-lancey@scouting,org
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of none New business
Business Name/Type: Boy Scouts of Amedca/Non-Profit Youth Organization
Previous Business on this site
Describe the proposed business including usc, number of employees, number of shifts, available parking spaces, number of
vehicles, and any additional information that you can provide:
G"pd4.acks, zero -employees* 10 12 upJunteors -
*This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move the use to anew location, anew Zoning
Clearance will be rtquin:d.
I hereby certify that I own or have the owners permission to use the spncc indicntcd on this application. I also certify that the information provided
is true and accumtc to the best ofmy 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
( J Approved 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 r?:A2'
Zoning Official pate
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 1 1/02/2015 Paige 2 of 3
11-25-19;12.51PM;
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Intake to complete the following:
Y Cn
Is LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet,
Y %
Wilkhere 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 lic water?
If private well, provide HeALli Dcpartrnent form,
Zoning review can not begin until we receive approval from Health
Dept, FAX DATE
Circle the one that applies -
is parcel on septic or Oblic sewer?
Reviewer to complete the Mewing:
Square footage of Use: - —~
Y N11
Fornitted as:
Under Section:
Supplementary regulations section: - --�.
Parking formula: A)
/
Required spaces:
Y/N
Items to be verified in the field:
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit # Inspector
Y / J Notes:
Willtere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zonino to com lete the followin :
Violatiops:
Y %/N/
ifso, ist
CA��P�!)
Proffers:
Y A'/ist:
ifs _
Vnri e:
Y /rN`-�Y/N
if s st:
_
SP's:
If so, List;
Clea rnnces:
SDP's
��1D--Lfi`t
Revised 1 I /1 /2015 Page 3 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, C t- 'ZOI — Z7 l
[County application name and number]
was provided to `k \,A �� the owner of record of Tax Map
[name(s) of the re ord owners of the parcel]
and Parcel Number "l j—
manner identified below:
by delivering a copy of the application in the
Hand 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
[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
to the following address:
[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 l
Print Applicant Name
Date
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