HomeMy WebLinkAboutCLE201900212 Approval - County 2022-06-22Application for Zonin Clearance
CLE #,1()%IOU,, (�
OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS Check# US-G Date:
Receipt # ( stag:
PARCEL INFORMATION
Tax Map and Parcel: D ) 6 F/-. 66— Qd —BD ZD v Existing Zoning
Parcel Owner: Clover Lawn East, LLC
Parcel Address: 325 Four Leaf L to 5 City Charlottesville State VA
(includes ' Boor)
PRIMARY CONTACT
Who should we call/write concerning this project? Becca Miller
Address :204 W Hampton St _ City Staunton state VA
Zip 22903
Zip 24401
Office Phone: (540) 213-3900 Cell # 540-831-9690 Fax # 540-213-0645 E-mail dominosbeccae2mail.com
Check any that apply: X Change of ownership _ Change of use _Change of name New business
Business Name/Type: Domino's Pizza 1 Si
pp
Previous Business on this site Domino's Pizza f*- LL E 7-0O6-247
Describe the proposed business including use, number of employees, number of shifts, available parldng spaces, number of
vehicles, and any additional information that you can provide: Q,Zzw O.i,t �and C r d IS eM le t(5� Sl's�•[1s o100.�ai1c�bLt O�-/tClrt Luc r.0 .T—i p i
*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 locazion, a new Z
Clearance will be required. oning
1 hereby certify that I own or have the owners permission to use the space indicated on this application. I also certify that the information provided
is true andte to the bIP� t of my 1 owledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature < , `�-�-v Printed Becca Miller
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, xi 17.
[ ] No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
site plan. Ir tA- 4Je1rq114e
[ ] This site complies with the site plan as of this date.
Notes: C& E 2_O,0b— 2 [?
Building Official
Zoning Official
Other Official VV FL cylliv
Date
l
Date / —/0-
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
Cl F 2of 9- ^ l Z.
Intake to complete the following:
Y
Is u n LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
N
Yi
dill 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 li er?
If private well, provide He epartment 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 ic sewe
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit#
the
Y
If ist: .Z646 ^2-v
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zeo�-I�s
Vag' e:
Y!/Ns
Ifs ist:
d�-f39 —�t7
2ot7 2sy 4015 si
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to complete the
Square footage of Use: 1,1167
-P'ermitted as: �L� l`L/t^Y eel
Under Section: 2 S. I I
Supplementary regulations section:
Parking formula: + /Zo [A 99 9
Required spaces: Ds—
ItemsY/N to be verified in the field: (/"Zb
Inspector:
Notes:
Y/UNJ
If so, List:
SP's:
Y/N
If so, List:
Revised 11/12015 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,
[County application name and number]
was provided to C lover "el E«.F LLC
[name(s) of the record owners of the parcel] the owner of record of Tax Map
and Parcel Number _
manner identified below:
delivering a copy of the application in the
Q 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 Clover Lawn East, LLC Benton Downer
[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 8/30/2019 Date to the following address:
PO BOX 17 Charlottesville, VA 22902
[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].
Si"latuie of Applicant
terra M, I I Q r
Print Applicant Name
_ $13ol zo1 1
Date
EXHIBIT A
Tax Map Parcels 56171-1 and 56171-2, consisting of two commercial pad sites located in the County of
Albemarle, Virginia, or more commonly known as Shoppes of Clover Lawn.
Site Plan of Shopping Center Land
(See Attached)
r WA
FUTURE STAIR AND
ADA BATH. PER
TENANT'S PLAN
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1167.7 S.F.
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ver Lawn Village — East Building 23APRIL20M SK
/von Scorch Architects Iomceda 0:, 412aae.s;azer001NVS 1332 Chadottesville, VA 22902 H. 141W 1 Iwm lawn,Coermerclal 9NlCIrg1
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