HomeMy WebLinkAboutCLE201500264 Application 2015-12-21r' C�f+1iF` iiSly' N'LV
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Tax Map and Parcel; 04581 -05 -OA -01000 Exisitnff Z -0 -din
Parcel Owner: currently WilcoHess LLC but they are merging into Speedway LLC on 01/01/2016
i?rrcci AtIJ, etc 2235 Seminole Lane city Charlottesville � 4_t# VA �,22901
(irzlle& suite ar t3 imrr)� y
t { . Sherry Sowry, Licensing Coordinator
�,'�i: u xhonlrl � s:. Al_J�a•i.�; cor, �fi:at �� ; t;� is prr,�ect7
P.O.Box 1580 _ ty Springfield
,: 45501
AcP�ia� CK OH ........1
863-6870 C#►:, Fgssowry@speedway.com
.r� S"r.j.S_�.�a..r�..Li i ���:.�•v�3"a.,Y�?...c�,��.r�d
.ijoo< qny 1 4ai mal _T'�r .=$d'fDm�5y u':i:' C''Y`Si -°i'� �' 1 ..._��.... R'�3k a: Gl [?` " "•-,t a i'`;r:;�'y:�0
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Speedway LLC d/b/a Wilco #753
Previous Business on this site retail convenience store with gas
Describe the proposed business including ase, number of employees number of shifts, available parking spaces, number of
vehicles, and any additional information that you can provide, no change, retail convenience store with gas
! it r:t; , e I=. ill only 1.7i: din a I thy: pane it is ,} or move the t:.,c to a new loeatio,i, ,. rwa= Zen: °
Ci anec< wvilI ; ce':J.Jr:d.
I hereby certify that I own or
is true and dbwlrate Uvhe 6q
the owner's permission to use fire spade indicaW on this application, I also ccrti* that the information provided
ny knowledge. I have read the oonditions of approval, and I understand them, and that I will abide by thorn.
ITC -N.
l r;rd John Harris, Power of Attorney
[ ] Approved a posed L I Approved with conditions [ ] Denied
prevention device and/or currant test data needed for this site, Contact ACSA, 977-4511, xl 17.
[ ] No physical site inspection has been done for this clearance. Therefore, it is not a determination ofcompliancc with the existing
site plan.
I ] This site complies with the site plan as of this date.
Notes:
Building Official
Zoe !og Oracial
Other Official
Date { �� -( "t 1-
Da ';
z¢:�.9tEatff:3s:eI C(iF:+§.tTuwty�.�a�r'wC:
401 Cir#i b .l sad i:1�«,f lotto vil r, zJrp. 2237], 4Jai .w: {134) &-: 3, :.: (434) 9'12-4126
Revised 1111/2015 Page 2 of 3
Intake to complete the following:
Yl
Is usVfn LI, HI or PD]P zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
IN
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
Reviewer to complete the following:
Square footage of Use: _ ;�-7( ()_
I N
Permitted as: 1P,3 b Z&�P
Under Section: _ -�—- 2 . d
Supplementary regulations section:
Circle the one that applies Parking formula: C
Is parcel on private well or �c w er? J %�•�r9
If private well, provide Healent form.
Zoning review can not begin until we receive approval from Health Required spaces:
Dept. FAX DATE
Circle the one that applies
Is parcel on septic or
Y/N
Will you be putting up a new sign of any kind?
Sign permit.
Permit #
YIN
Items to be verified in the field:
If so, obtain proper
Inspector • Date:
Y / N Notes:
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Viola ' ns:
Y) Il
If so, ist:
Proffers:
Yl
If so', -fist:
Variance:
C9/N
If so, List: O J
7
SP's.
Y/
If so, ist:
—
Clearances:
SDP's
Revised 11/1/2015 Page 3 bf 3