HomeMy WebLinkAboutCLE200800170 Legacy Document 2013-02-19Application for Zon Clearance
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PARCEL INFORMATION
Tax Map and Parcel: 03200-00-00-07co Existing Zoning
Parcel Owner: Mary Mercer
Parcel Address: 3489 Seminole TH. City Charlottesville State Virginia Zip 22911
(include suite or floor)
PRIMARY CONTACT
Eric Lyles
Who should we call/write concerning this project?
Address: 104 Wilmot Rd., MS 1435 City 'Deerfield State Illinois Zip 60015
Office Phone: (_L47) 315-3404 Cell # Fax # 847-368-6526 E-mail eric.lyies@walgreens.com
APPLICANT INFORMATION
Business Name/Tv p e: Walgreens #09417 Retail Drug Store and Sundries
Previous Business on this site
Describe the,proposed business including use,, number,of employees, nu I mber of shifts, available parking spaces, number of
I
vehicles, and any additional information that you can provide: Retail Drug Store and Sundries, One Hour Photo
Approximate 25 employees - Hours of Operation 8:00 AM - 10:00 PM all seven days of the week
*This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move the use to a tiew.location, a new Zoning
.Clearance will be required.
I. hereby certify that I own or have owners permission to use the. he, space indicated I on this application: I also certify that,the i nf6rinAtio :n r provided
is true and accurate t e best iy knowledge. I have read the conditions of approval, and I understand them, and that I will abide'by them.
Signature Printed Eric Lyles License Specialist New.Stores
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Other Official -I R
.County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
Revised 04/29/08 Page 2 of 3
Intake to complete the following:
Y
Is 6mLI,HI or PDIP zoning? If so; give applicant a Certified
Engineer's Report (CER) packet.
Y/ N�
MU, sere 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 1) blr?
If private well, provide Healfaepat eat form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that appli
Is parcel on septic or Oublie se er?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit. ?
Permit #
A N ;
ill there be any new construction or renovations?
'If-so, obtain the proper Permit.
Permit # P7n A /' -7
Zoning to complete the followine:
Reviewer to complete the following:
Square footage of Use: Iyr y ,� o
� / N /
Permitted as: V re-4au
Under Section: aC T C�• I
Supplementary regulations section:
11a
Parking formula:
Required spaces:
S 04
Y/N
Items to be verified in the field:
:Inspector t � %� i� "4416
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Notes:
Clearances: SDP's
Revised 01/28%08 Page 3 of 3