HomeMy WebLinkAboutCLE200800230 Legacy Document 2013-03-18Building Permit #
B2007- 01322NC
Application for Zoning Clearance
CLE # �00& D Z�Q
�RGNIP
PARCEL INFORMATION
Tax Map and Parcel: 59D2 -1 Parcel 2 Existing Zoning HC
Parcel Owner: University of Virginia Host Properties
Parcel Address: 505 Berwick Road City Charlotte svi1&te VA Zip 22903
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? Michael Stumbaugh
Address: P -0. Box 400218 City Charlotte svi 181file VA Zip 2290
Office Phone: L33 982 -3777 Cell #531 -1938 Fax #982 -4852 E -mail stum @virginia.edu
I APPLICANT INFORMATION I
Business Name/Type: Boar's Head Inn Meeting Pavilion
Previous Business on this site None
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: Conference Center / Meeting Facllit
*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 accuratVo the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature y Printed � i �
C
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:
❑ YES NO
Is use in LI, I or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
❑ YES Y�_NO
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
❑ YES NO
Is parcel on private well or public water?
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
❑ YES ❑/O
Is parcel on septic or public sewer?
Reviewer to complete the following:
Square footage of Use:
YES ❑ NO I
Permitted as: `C 5
Under Section:
Supplementary regulat1ons section:
Parking formula: P -1'10VVv
Required spaces:
l�
YES ❑ NO
Items to be v� erifie in th Lld;
❑ YES E� NO
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit # Inspector
YES ❑ NO N
III there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #�- ti2ll/
/joning it ecn to vomplete the tollowmg:
Violations:
❑ YES NO
If so, List:
Variance:
❑ YES Ql�O
If so, List:
Proffers:
ES ❑ NO
If so, List:
?,AAA- O` -15
SP's:
C[ YES It/,N/10
If so, List: �q .. 3
Date:
5/1/06 Page 3 of 3