HomeMy WebLinkAboutCLE201600062 Application 2016-03-24Application for Zoning Clearance
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OFFICE U �l +
PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Receipt # Staff
PARCEL INFORMATION
Tax Map and Parcel; Existing Zoning__PD-MC
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Parcel Owner: 5th Street Station Ventures, LLC
Parcel Address: 250 Merchant Walk Ave., Suite 1101 City Charlottesville State Virginia
Zip 22902
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? Dan Tucker
Address • 5 SW Broad Street, Suite B City Fairburn State Georgia
Zip 30213
Office Phone: C7 } 692-8300 Cell # 434 245-4909 Fax ## (770) 692-8302 E-mail _dan(d)sicollinsent.corn
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name x New business
Business Name/Type: Hand and Stone/ Mercantile
Previous Business on this site mostly undeveloped site
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: This 2,496 square foot Hand and Stone (mercantile)
business has
*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 th at the information provided
is true and accurate to.the best of my knowledge. I have read the conditions of approval, and I understand thein, and that I will abide by them.
Signature��4 if
Printed �� 1 t-_Ljr
APPROVAL INVORMATION
JX Approved as proposed [ ] Approved with conditions [ ] Denied
{ j Backflow prevention device and/or current test data needed for this site. Contact ACSA, 9774511, xl 17.
[ ] 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,-- 31k=�
Z
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/0
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
Y /i I
If so, give applicant a Certified
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 . public wat r?
If private well, provide Hea ent form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that a s°
Is parcel on septi or public sewe
YIN
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
V/ N
Will there be any new construction or renovations?
If so, obtain the proper Permit
Permit #.-. A�
Zoning to comDlete the followine:
Reviewer to complete the following:
Square footage of Use:
CY)IN
Permitted as: r E
Under Section: 2514 •
Supplementary regulations section:
Parking formula:
` 7J7
Required spaces:
YI
Item be verified in the field:
Inspector • Date:
Notes:
Viola ns:
Y/
If so, List:
Proffers:
&/N
If so, List: q
Gigli, ,/ _
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a �
Vari nee:
Y 1(
If so,Et:
SP's•
Y 1`T
If so, List:
Clearances:
SDP's
Revised 11/1/2415 Page 3 of 3