HomeMy WebLinkAboutCLE201600063 Application 2016-04-09Application for Zoning Clearances
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OFFICE USE Y
PLEASE REVIEW ALL 3 SHEETS
Check # / Date: -
Receipt # /DJS' Staff:
PARCEL INFORMATION
Tax Map and Parcel: 03200-00-00-042AO Existing Zoning Planned Development Mixed -
Parcel Owner: Route 29 LLC
Parcel Address: 341 Towncenter Dane, Suite 300A City Charlottesville State Virginia Zip 24401
(include suite or floor)
PRIMARY CONTACT
Thomas Hutton
Who should we call/write concerning this project?
Address • 204 W. Hampton St. city Staunton State VA Zip 24401
Office Phone: 4,400 �13-3900 Cell # 540-476-2755 Fax # 540-213-0645 E-mail sig9984@gm2ilcom
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name XX New business
Business Name/Type: Domino's Pizza #4241 Pizza Delivery and Take Out: Pizza, Sandwiches, etc MENU Attached
Previous Business on this site None: new building Building Permit # B2015-00362-AC
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicles, and ny additional information that you can provide: P ' ` O i' r a" C-a
rrl P f o - k • „ a f-
0DO a t*-Verx I, 2 f
*This Clearance will only be valid on the parcel for wh' t is approved. If you change, intensify or ove the use to a ncfv location, ailfw Zoning i
Clearance will be required.
I hereby certify that I own or have the owners permission to use the space indicated on this application. I also certify that the information provided
is true and accurate to the best of lmow . I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature printed Thomas J Hutton
APPROVAL INFORMATION
'Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Bachflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, xi 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 z1/ -? /' -6
,6
Other Official ��j Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 9724126
Revised 11/02/2015 page 2 of 3
Intake to complete the following:
Y 1 T
Is use in LI, HI or PDiP zoning'? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y l 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 a .b
Circle the one that applies o
Is parcel on private well orp"oll ee wa- ter
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 applies
Is parcel on septic or.pa lic sewer?
YIN
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 # j
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: Ago D
0)/N ,
Permitted as: e&hAhY,.� y ✓.
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces:
Y I
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
0 / N
If so, List:
offers:
(�/N
If so, List:
!
2d14
Variance:
L9/NIN
If so, List:
If so, List:
Clearances:
SDP's
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Revised I1/1/2015 Page 3 of
In Cooperation with the
State Department of Health
Phone (434) 972-6219
Fax (434) 972-4310
Thomas J. Hutton
204 W. Hampton St.
Staunton, VA 24401
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C-DOMMONWEALT I of VIRGINIA
Thomas Jefferson Health District
1138 Rose Hill Drive
P. O. Box 7546
Charlottesville, Virginia 22906
May 11.2015
ALBEMARLE-CHARLorTESVILLE
FLUVANNAGOUNTY (KW"RA)
GREENECOUNTY ISTANARDSVILLE)
LOUISA COUNTY(LOUISA).
NELSON COUNTY (LOVINGSTON)
RE: Plan review status—Domlao's, 341 Town Center Lane, Charlottesville, VA 22901
Dear Mr. Hutton,
Thank you for your detailed plan review submission. The plans have been reviewed by this
department and are approved.
Should you have any questions during the construction process or need additional information,
please do not hesitate to contact me.
Sincerely,
K- Eric Stutz, MPH, REHS
Environmental Health Specialist, Sr.
(434)972-6261
Cc: Hunter W. Wood
File