HomeMy WebLinkAboutCLE200900027 Legacy Document 2012-08-27Application for Zoning Clearance
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® Zoning Clearance = S35
OFFICE USE ONLY
Check # I �ZJ ll�� Date: a 2'�SQG/
PLEASE. REVIEW ALL 3 SHEETS
Receipt # - `' Z Staff.
PARCEL INFORMATION
Tax Map and Parcel: TM 56 Parcel 110 Existing Zoning HC
Parcel Owner: Preston O Stallings
Parcel Address: 545 Radford Lane City Charlottesville State VA Zip 22903
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? Lori Ramsey, Corporate Compliance Auditor -Harris Teeter, Inc
Address: 701 Crestdale Road City Matthews State NC Zip 28105
Office Phone: (124_) 844 -3489 Cell # Fax # 704- 844 -65 E -mail Lramsey @harristeeter.com
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name XX New business
Business Name/Type: Harris Teeter, Inc
Previous Business on this site n/a
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: retail gocery supermarket, approx 125 employees,
open 24 hours parking is available
*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 a own or h• ve the owner's permission to use the space indicated on this application. I also certify that the information provided
is true and acc ra to the best my knowledge. I have read the conditions of approval, and I understand them. and that i will abide by them.
Signature Printed Lori Ramsey
APPROVAL INFORMATION
Y , Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 9774511, x 119.
[ ] 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
Zoning Official Date
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 04/28/08 Page 2 of 3
Intake to complete the following:
Is/
[s us L[, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/N
Will 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 apph
Is parcel on private well o pubr?
If private well, provide He h nt 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 tic sr�►er.
N
i11 you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
0 / N
Will there be any new construction or renovations?
If so, obtain the proper PerrOit,
Permit # 2 dL�e -1- 6 %?✓�U
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: `I , yJ 0
YJ/ N
ermittedas: ,1,>cc,,, /e
v `
Under Section: 6>
Supplementary regulations section:
Parking formula:
Required spaces:
It /�N J
Ite o be verified in the field:
Inspector: Date:
Notes:
Viola ions:
Y /1!
If so, List:
Proffers:
Y �N
Ifso, List:
Variance:
Y/(�)
If so, List:
'P's:
/N
so, List:
Clearances: �
�
SDP's
nQ --
Revised 04 /28/08 Page 3 of 3