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HomeMy WebLinkAboutCLE201900275 Application 2020-03-2711-25-19;12;38PM; ;5409436676 # 6/ 7 Application f, Clearance r ning CLE # , OFFICE U NLY PLEASE REVIEW ALL 3 SHEETS Check# Dom: �J Receipt # St Of. PARCEL INFORMATION Tax Map and Parcel: 56A2-01-29 Existing Zoning Parcel Owner: Crozet Center Partners LLC Parcel Address: 5734 Three Notch'd Rd City Crozet State VA Lip 22932 (include suite or floor) PRIMARY CONTACT Who should we enlVwrite 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 scottlerxwy@scouting.org APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of saw New business Business Name/Type. goy Scouts of America/Non-Profit Youth Organization 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: "This Clearance will only be valid on the parcel for which it is upproved. tfyou change, intensify or move the uft to a new location, a new Zoning Clearance will be required- 1 hereby certify thnt I own or have the owner's permission to use the spucc indicated on this application, t also certify that the information provided is true and accurate to the beet ol'my knowledge. l have read the conditions ol'approval, and 1 wtderstand them, and that I will abide by them. Signature Printed Scott M. Lancey Ik APPROVAL INFORMATIO ( ] Approved as proposed [ ] Approved with conditions [ ] Denied ( J 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 'G' Dote Zoning Official Date Other Official Date County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 29"832 Fax: (434) 972-4126 Revised 11/02/2015 Page 2 of 3 11-25-19;12:38PM; ;5409436676 # 7/ 7 Intake to complete the following: Y /(� \, Is use in Li, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y Wilt ere be food preparation? If so, give applicant a Health Department form. Zoning review can not begin until we receive approval from Health Dept. PAX DATE Circle the one that applies / — , Is parcel on private well orp�??xilic wntet 1) If private well, provide Hea"partrrient 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 pu is sere Reviewer to complete tie following: Square footage of Use: -- Permitted as: /,f V V Under Section: Supplementary regulations section: Parking formula: Required spaces: I r�& cec�C �t —5 rt � 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 / Notes: Wil tyre be any new construction or renovations? If so, obtain the proper Permit. Permit Zoning to complete the followin : Violations: Y / Ifso.L: Proff rs. Y /'N Ifsb; List: Variance: Y /�Nl If sgist: y Y N f so List: Clcnrances: SDP's 7r1'K-lLit P c-, Revised 11/]/2015 Page 3 of 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- L- f— Z© ( c — Z 75 was provided to M-AOt — GT5 .0 [County application name and number] the owner of record of Tax an [name(s) of the record owners of the parcel] and Parcel Number 5L'-",'— —�� by delivering a copy of the application in the manner identified below: © Hand delivering a copy of the application to 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] CIZ EO on _I \ "tyl�f'd�b1� 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]. Signature of Applicant Print Applicant Name !<i�-VDcC- 201z�? Date