HomeMy WebLinkAboutCLE201700262 Application 2017-11-21Application for Zoning Clearance`°'�
CLE # - k
�
-MIR _
OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Receipt # staff..
PARCEL INFORMATION
Tax Map and Parcel: 45-111-A Existing Zoning N -
Parcel Owner: Planters Bank & Trust (Union Bank)
Parcel Address: 410 Gander Dr City Charlottesville State VA Zip 22901
(include suite or floor)
PRIMARY CONTACT
Who should we calt/write concerning this project? Scott Lancey
Address: 810 Hopeman Pkwy City Waynesboro State VA Zip 22980
Office Phone: (540) 943-6675 Cell # 540-461-2171 Fax # 434-234-0241 E-mail scott.lancey@scouting.org
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: Boy 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:
Chr*stmac Tree lotand racks, zero employees,1 9 12 vol-Ate-ers-
*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 1 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 be t of my knowledge. I have read the conditions of approval, and I understand them, and that 1 will abide by them.
Signature _ Printed Scott M. Lancey
AP OVAL INFORMATIO
[1 Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] 9Backfiow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, x 117.
[v,rNo 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 2�
Zoning Official �l VV �,'�a_ rP Date 11 Z 1 l -7
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
Intake to complete the following:
Y/N
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y i`th Wil ere 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 r public water?
if private well, provide Hea apartment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that appli
Is parcel on septic o public sewer?
Y /) N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit # `TS 10 j 1 - 11 S 1(6
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit # __ h I-
I
Zonin to complete the following:
Reviewer to complete the following:
Square footage of Use: i 1� (J
Y UN
as:
Under Section: QAtli IV) D'ig(1((✓
Supplementary regulations section:
Parking formula:
flag
Required spaces:
Y/N
Ite o be verified in the field:
Inspector Date:
Notes:
Viola 'ons:
Y N
If st:
Pro
Y/N
If 7ist:
Variance:
Y/N
If ist:
's:
Y/N
so, List:
Clearances:
SDP's
011-ys
Revised 11/1/2015 Page 3 of 3