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HomeMy WebLinkAboutCLE201200191 Legacy Document 2012-09-10Application for Zoning Clearance ryv`aase CLE # J;.'1:� 1. OFFICE U NLY PLEASE REVIEW ALL 3 SHEETS Check # Date: - Receipt # Staff: 1 PARCEL INFORMATION �U : '- Tax Map and Parcel: ©UI; � 03-00— O i l G Existing Zoning L Parcel Owner: �'7�lLJ1t��CJ�GS !7`�C� LLB Parcel Address: 571 Branchlands Boulevard City Charlottesville State VA Zip 22901 (include suite or floor) PRIMARY CONTACT Who should we call /write concerning this project? Potomac Family Dining Group Operating Company LLC - Keith Litrenta, CFO Address : 13873 Park Center Rd, Ste 316 S City Herndon, State VA Zip 20171 Office Phone: 2( 40) 752 -7578 Cell # Fax # 443 - 200 -1545 E -mail klitrenta @potomacdining.com APPLICANT INFORMATION Check any that apply: )L_ Change of ownership Change of use Change of name New business Business Name /Type: Restaurant Previous Business on this site Restaurant 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: Inp Ch e/--5 U Cor pQni- 0m, --/ e ny lo'y s *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 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 accurate 't th est of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them. Signature C Printed lk:�4r7ThL L I TR S�?V—IA 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, 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 Date Zoning Official Date V-7 /2.01 v 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 7/l/2011 Page 2 of 3 z(