HomeMy WebLinkAboutCLE201300103 Legacy Document 2013-07-05kou L�( t
Application for Zoning Clearances:
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CLE # 2D I.� ° �b
OFFICE USE ONLY
°J I VJ5 -13 ' I3
PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Receipt #J l Staff:
PARCEL INFORMATION
Tax Map and Parcel: 03200-00-00-037C1 Existing Zoning HC
Parcel Owner: DEMARY R & GEORGE R MERCER SR. TRUST
13 -l1
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Parcel Address: City D T : �L1T/,� State VA Zip 23-2-2-6
(include suite or floor)
PRIMARY CONTACT
LOU COWAN
Who should we call /write concerning this project?
Address: 438 E. WILSON BRIDGE RD., #100 City WORTHINGTON State OH Zip 43085
Office Phone: (614) 436-0100 Cell # N/A Fax # N/A E-maillcowan@cowanandassociates.com
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name x New business
Business Name /Type: ADVANCE AUTO PARTS
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 SALES /MERCANTILE, 5 -8 EMPLOYEES
FT S, 58 PARKING SPACES, 10-12 VEHICLES
*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 to the of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
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Signature ,�L� Printed LOU COWAN
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 1/ _7/x%3
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 7/1/2011 Page 2 of 3
Intake to complete the following:
Y /6
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y /N
WiNlIere 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 o public wate .
If private well, provide Hea epartment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic o public sewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permi
Permit #�,
Y/N
Will there be any new construction or renovations?
If so, obta' the proper Permit.
Permit #j
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: t) C?
O/N y
Permitted as: 1�e - +,A t
Under Section: 'LL/.2
Supplementary regulations section:
Parking formula: k L' j pub , ?�,���
Required spaces: y
Y /1C1
Items o be verified in the field:
Inspector : Date:
Notes:
Viola. ions:
Y/
If so, ist:
Proffers:
Y/
If so, ist:
Variance:
If so,ll�L//ist:
SP's
Y/N
If so, List:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3
CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
This form must accompany zoning applications (Home Occupation, Zoning Clearance, Zoning
Administrator Determinations or Appeals, Sign Permits, Building Permits) if the application is not the
owner.
I certify that notice of the application, ALBEMARLE COUNTY #2013586
County application name and number]
DEMARY R & GEORGE R ME4CER S1� TRUST
was provided to ATTN : NICOLE E ROYCE the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number 03200-00-00-037C1 by delivering a copy of the application in the
manner identified below:
X
Hand delivering a copy of the application to
[Name of the record owner if the record owner is a
person; if the owner of record is an entity, identify the recipient of the record and the recipient's
title or office for that entity]
Oil
Date
DEMARY R & GEORGE R MERCER SR. TRUST
Mailing a copy of the application to ATTN : NI COLE BOYCE
[Name of the record owner if the record owner is a person;
if the owner of record is an entity, identify the recipient of the record and the recipient's title or
office for that entity]
Oil 5/10/13 to the following address:
Date
7201 GLEN FOREST DR. SUITE 311, RICHMOND, VA 23226
[address; written notice mailed to the owner at the last known address of the owner as shown on
the current real estate tax assessment books or current real estate tax assessment records satisfies
this requirement].
Signature of Applicant
LOU COWAN
Print Applicant Name
5/10/13
Date