HomeMy WebLinkAboutCLE201500037 Legacy Document 2015-03-26Application for Zoning Clearance►�'��
CLE # 2015- 37
OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS
Check # I (OZ8 Date: 3 13 / 6
Receipt # q8q55 Staff:
PARCEL INFORMATION
Tax Map and Parcel: 061 MO -00-12-001 DO Existing Zoning PDSC
Parcel Owner: FR Shoppers World, LLC
(230 29th Place Court)
Parcel Address: 230 Shoppers World Court City Charlottesville State VA Zip 22901
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? MUY Pizza Southeast, LLC
Address :17890 Blanco Road, Suite 401 City San Antonio State TX Zip 78232
Office Phone:2( 10) 408-2400 Cell # Fax # 210-858-0829 E-mail wendy.melendez@muycompanies.com
APPLICANT INFORMATION
Check any that apply: x Change of ownership Change of use Change of name New business
Business Name/Type: MUY Pizza Southeast, LLC dba Pizza Hut #31214/ Restaurant
Previous Business on this site Pizza Hut
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: Restaurant, 14 empbyees
*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 X have the owner's permission to use the space indicated on this application. I also certify that the information provided
.is true and accur to to the t of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed James H. Bodenstedt
APPROVAVINFORMATION
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 '-f t(
Zoning Official Date
Other Official /7 L7 Date j/bZ-b
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
e._
Intake to complete the following:
Y /6
Is use in LI, HIor PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
N
ill 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
Circle the one that applies
Is parcel on private well pc wubliter?
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 e,ap lies
Is parcel on septic o public se r?
Y /
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: /357-
& / N 357-
&/N
Permitted as: �9
Under Section: ;2 •/
Supplementary regulations section:
Parking formula: j 1
6 Gz J A� ��C✓
Required spaces: ,
Y /(
Items to be verified in the field:
Inspector:
Notes:
Date:
Violations:
If so, ist:
Proff rs:
If s , ist:
Vari nce:
Y/
If so, List:
SP's•
Y/
If so, ist:
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,
[County application name and number]
was provided to FR Shoppers Word. LLC the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number
manner identified below:
by delivering a copy of the application in the
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]
rn
Date
X 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:
1626 East Jefferson Street, Rockville, MD 20852-4041
[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].
00)t�,-
Sietultgof Applicant
James H. Bodenstedt
Print Applicant Name
2/26/2015
Date
I