HomeMy WebLinkAboutCLE201600071 Application 2016-04-26Application for
Zoning Clearance
0
CLE
OFFICE'S Y
PLEASE REVIEW ALL 3 SHEETS
Check# " Date:
Receipt # Staff
PARCEL INFORMATION
Tax Map and Parcel:
Eiristing Zoning _ PD-MC
Parcel Owner: 5th Street Station Ventures LLC
Parcel Address: 265 Merchant Walk Square, Bldg. 1000 City Charlottesville StateVirginia
Zip 22902
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project?
Dan Tucker
Address: 5 SW Broad Street, Suite 8
City Fairbum State Georgia
Zip 30213
Offlee Phone. (770) 692-8300 Cell # (434) 245_49091. Fax # . (770) 692-8302 &mail dan sicollinsent.com _
APPLICANT INFORMATION
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Business Name/Type:
Sprint (Suite 1003)1 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 2,002 square foot Sprint (mercantile) business
*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 certi4r that the information provided
is true and accurate to the best ofmy knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature
Printed r
APPROVAL INFMMATION
J] Approved as proposed [ ] Approved with conditions ( ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, xl I7.
[ ] 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 C Date(a
s %
Zoning Official Date / Z�
Other Official Date
County of Albemarle Department of Community Development
401 Mclutire Road Charlottesville, NIA 22902 N'oice: (434) 296-5832 Fax: (434) 972-4126
Revised 7/1/2011 Page 2 of 3
Intake to complete the following:
Y /a
Is use in LI, III or PDIP zoning?
Engineer's Report (CER) packet.
Y/])
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
Reviewer to complete the following:
Square footage of Use: ;Z- 4X5 S'
I I N
Permitted as: ' �1`! ► I
Under Section: Zg 2 •! _
Supplementary regulations section:
Circle the one that applies Parking formula: q S
Is parcel on private well or. u ater?
If private well, provide Hea artment form.
Zoning review can not begin until we receive approval from Health Required spaces:
Dept. FAX DATE
Y/N
Circle the one that appli Items to be verified in the field:
Is parcel on septic or ublic sewe .
YIN
Will you be putting up a new sign of any kind?
Sign permit.
Permit #
If so, obtain proper I
Y/N
Will there be any new construction or renovations7
If so, obtain the proper Permit.
Permit #
Zo-ning to complete the following:
Inspector:
Notes:
Date:
Violati ns:
Yle
If so, ist:
kroffers:
iY)/N
I so, List:
b 6- 9
p$_
Var' e:
Y/
If so, List:
SP'
Y/s: O
If so, List:
Clearances:
SDP's
Revised 7/l/2011 Page 3 of