HomeMy WebLinkAboutCLE201300221 Legacy Document 2013-09-246A
Application for Zonin Clearance;z�
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PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Staff:
Receipt #
PARCEL INFORMATION
Tax Map and Parcel: Tax Map 45, Parcel 110 Existing Zoning HC - Highway Commercial
First Gold Leaf Land Trust
Parcel Owner:
Parcel Address: 440 Gander Road City Charlottesville State VA Zip 22901
, (include suite or floor)
PRIMARY CONTACT Nick Messina
Who should we call /write concerning this project?
Address : P. O. Box 891269 City Tampa State FL Zip 33689
Office Phone: 8( 13) 653 -1125 Cell # Fax # E-mail nick.messina @brooks- amaden.com
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name X New business
Nick Messina on behalf of Gander Mountain Company / Retail
Business Name /Type:
Previous Business on this site None - Vacant Lot
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:. Outdoor sporting goods retail, # of employees varies by season,
overlapping shifts, 196 parking spaces provided, # of vehicles is based on customer counts with seasonal variation.
*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 best of y knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
'
Signature Printed Nicholas J. Messina
AL INFORMATION
roved as proposed [ ] Approved with conditions [ ] Denied
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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 ZA Date l/hi /• J
Other Official Date
County 02 Atoemarle UeparG11e11L V1 %- Vluuluu,L.Y
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 7/1/2011 Page 2 of 3
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Intake to complete the following:
Y QN
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y h
Will t ere 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 wet r ublic water?
If private well, provide 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 septic o ublic sewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign perm'
Permit #
Y/N
Will there be any new construction or renovations?
If so, obt pqhp errrli.r�
Permit #1:
Reviewer to complete the fol
Square footage of Use: 1. 2di qU 1666
R1
mitted as:
Under Section:`"I • .
Supplementary regulations section:
Parking formula:
Required spaces: •' j
Y/N
Items to be verified in the field:
Inspector : „r± It, Date:
Notes:
(.RJII(rA LV GVIR AGI.G I.A1G 1V llv ♦r aaa
Viol ' ns:
Y / N
If sd;Sist:
Proffer ••
Y /t J .,
If so,,Mst:
Variance:
Y /(I�
If so, 'ist:'
SP's
Y
If so, Ist;
Clearances:
SDP's r
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Revised 7/1/2011 Page 3 of 3
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2.
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,
[County application name and number]
was provided to the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number by delivering a copy of the application in the
manner identified below:
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]
r•
Date
Mailing 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]
on
Date
to the following address:
[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].
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Signature of A plicant r
Nicholas J. Messina
Print Applicant Name
September 13, 2013
Date
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