HomeMy WebLinkAboutCLE201900003 Approval - County 2022-06-22Application for Zoning Clearance
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CLE # oo�,Y„a<'
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # ] _7U(0 Date:
Receipt # Staff:
PARCEL INFORMATION
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Tax Map and Parcel: 061 WO-03-00-019AO Existing Zoning
Parcel Owner: Comcast of CA/MD/PA/VA/WV, LLC
Parcel Address:3912 Lenox Ave, #310 City Charlottesville State VA Zip 22901
(include suite or Floor)
PRIMARY CONTACT
Who should we call/write concerning this project? Tom Donnelly
Address : 1701 John F Kennedy Blvd, 32nd FI City Philadelphia State PA Zip 19103
Office Phone: 2( 15) 286-7557 Cell # Fax # 215-286-1048 E-mail bridget_miles@comcast.com
APPLICANT INFORMATION
Check any that apply:_ Change of ownership Change of use Change of name x New business
Business Name/Type: Comcast of CA/MD/PANA/WV, LLC
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:
Ret8il stoco 12employees Hours AAen 2at_9A 7P, Sun 12 5P
-This Clearance will only be valid on the parcel far which it is approved. If you change, intensify or move the use to anew location, anew Zoning
Clearance will be required.
I hereby certify that I 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 accurattLto.Wbest off my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature �"�' r f10*11 r(.la+Y1 Printed Tom Donnelly
INFORMATION
AfPROVAL
[ Approved as proposed [ I 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.
[ ] This site complies with the site plan as of this date.
Notes:
Building Official `-?'��✓(!`� s Date // /
Zoning Official Date Ilit/ l k
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 246-5832 Fax: (434) 972-4126
Revised 11/02/2015 Page 2 of
Intake to complete the following:
Y(N,/
Is use ut LL HI or PDIP zoning'?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y /
Will Ve 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 p blic w '?
If private well, provide Hcalth cpartment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE _________
Circle the one that app i
Is parcel on septic or p lieer'?
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 #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use:
4,585
Y/N r 1 Permitted as:
Under Section: G
Supplementary regulations section
Parking formula'
17vco
Required spaces:
Y N
Itc� be verified in the field:
Inspector : Date:
Notes:
lations:
N
f so, List: !
616 20- (,2- h i cr i cult 2
P ffers:
N
If so, List:
M J_x
l3 -
T�
ckoj� -Li -1
LIP0I — i
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V anc
Y / N
If so, List:
s:
Y / N
so, List:
Clearances:
SDP's
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1 3 3
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Revised 11/1/2015 Page 3 of 3
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