HomeMy WebLinkAboutCLE201500265 Application 2015-12-21.1�j�:I€ . -
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PARCEL
Tax Map and Parcel: 06100-00-00-120p0
Parcel Owner: currently WilcoHess LLC but they are merging into Speedway LLC on 01/01/2016
�rcrl d 1600 Seminole Trail "Pit Charlottesville Si"Tp VA 22901
(indide su!te or fu ; ')
V4ou should ,p+uj,,:tr Sherry Sowry, Licensing Coordinator
----
. P.O. Box 1580
Ci+y Springfield
st. t �; OH
zip, 45501
f'y t;e: 937 8636870 _T ., 1 A_ ,,, ,,, ssowry@speedway.com
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j�;,w➢z�s LYsza �ri'yizc: Speedway LLC d/b/a Wilco #755
Previous Business on this sift retail convenience store with gas
Describe the proposed business including use, number of employees number of shifts, available porlsing spaces, number of
vehicles, and any additional information that you can provide: no change, retail convenience store with gas I
Wrhi-,., CIe, ? zv wall only oa valid Crit tUr fc: watch it is :,;jp.F'0F.4. if �%-7 07.-nZ1,, irl3rri ry or t4nYC -'.'1C w.- i'.) a new let; diun, a r'v-'Y z0n,-3
Cee: r": Lt; ; Wil l t:e reg7fln.d.
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 urate my knowledge. I have read the conditions of approval, and i understand them, and that 1 will abide by them.
'..i:.LrC -11� Pri�Lt d John Harris, Power ofAttorney
12
as proposed [ ) Approved with conditions [ ] Denied
Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, xI 17.
[ j No physical site inspection has been done for this clearance. Therefore, it is not a determination of eotopHanco with the existing
site plan.
[ j This site compiles with the site plan as of this date.
Dotes:
Buf:ding Of idal Wt� I/gre_L_N_.-- —
Zoning Official J.
Other Official
aha �c
Cowityoz"Airt4uirl• of Com)ers'.jD"I-;q"wznt
401 iMc rilre Ros J Ca-;.r"ottez'vVle, YA 2291l2. Va ,T n (b".ij llr-6 `s3s I ao!v: (434) 9724126
Revised 11/1/2015 Page 2 of 3
Intake to complete the following:
Y/E)
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/ N
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
Circle the one that applies
Is parcel on private well Ater?
If private well, provide artment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that app
Is parcel on septic or " r?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
YIN
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: bj
W/N
Permitted as: Ly'
Under Section: L~�• ��
Supplementary regulations section:
Parking formula:
Required spaces:
YI IV
Items to be verified in the field:
Inspector : Date:
Notes:
Violat' ns:
Y 1
If so, is
Pro
Y l•
If so, ist:
Variance:
�11N
If so, List:
SP's:
Yl
If so, ist.
Clearances:
SDP's
Revised I l/l/2015 Page 3 bf 3