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HomeMy WebLinkAboutCLE201600162 Application 2016-10-27I ' Application Clearance � , CL # 2oI'n .._._..___....._.._.. ......__........... ._..... OFFICE ! ONLY PLEASEItI �TII` ' AI.I: III;I T5 Check # �U 3 � Date, i receipt # [©�� __ Staff: _ PARCEL INFORMATI i�_ _ .. Planned Development Tax Map and Parcel, 76M1-2 Existing oning Shopping Center Parcel Owner: 5th Street Sta. , LLC parcel Address: 425 Merchant Walk Ave City Charlottesville State Vir inia Zip 22902 (include suite or floor) - ...._....... PRi bIAl CONTACT Who should we call/write concerning this project? Brian Sredoj evic Address. 325 N. LaSalle St. Suite 500 City Chicago State Illinois Zip 60654 [ r Office Phone: (312)873-1070 Cell#� Fax U-mail brian.sredojevic@norr.cpm -- ........ -----........ .__._._ ... ......... APPLICANT INFORMATION Check any that apply: Change of ownership ___—._.._. Change of use Change of name X New business Business Name/Type; Blue Ridge Bread DBA Panera Bread i Previous Business on this site NA, this site is New Development Describe the proposed business including use, number of employees, number of shifts, available arking spaces, number of vehicles, and any additional information that you can provide: Panera Bread Restaurant with max 8 employe(,; per 3 shifts. Parking is being shared with tne shopping center tnat is being ull= 'This Clearance will only be valid on the parcel for which it is approved, Ifynu change, intensify car move the use to a new location, a newZoring Cicarance will be required. 1 hereby certify that 1 own or have the owner's nnission to use the space indicated on this application. I also certify that the information provided is true and accurate to the best ofmy I ow e. I have read the conditions of approval; and I understand them, and that I will abide by them. Signature Printed -&► SWO-e-Vii n - -- _. ___................................ ... ........ ..__-_._------- ___.._.. ,e�kP'ROVAL INFORMATION Approved as proposed [ ] Approved with conditions [ ] Denied ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, x117. [ ] 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 ofthis date. Notes: Building Official irate � � (`( � ( LZoningialal Date t ounty of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902'Voicec (434) 296-5832 Fax. (434) 972-4126 Revised 1111/20 t5 Page 2 of 3 Intake to complete the following- Y/O Is use in LI, 1-11 orPDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. N Will there be food preparation? If so, give applicant a Health Department form. Zoning review can not b fil we receive approval from Health Dept, FAX DATE Circle the one that applies -- Vi Is parcel oil private well or piwii " �— If private well, provide Health 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 Y / N Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # 0/ N Will there be any new construction or renovations? If so, obtain the proper Pen -nit, Permit # �2- dl� Reviewer to complete the following: Square footage of Use: -1/ 3 1 1-�, (I, / N Permitted as:ems%% ' / Under Section: Supplementary regulations section: Parking formula: 7 Required spaces: - Y Itt-I—Q— he verified in the field; Inspector : — Date: - Notes: - . .. . tv^ e Lj -t I ...... ....... Violations: Y /(9 If so, List: Proffers, 11a)/ N If so, List: . ....... .... sp's- Y / ) If Aist; Vari cc: Y If nee: Clearances. SDP's Revised 11/1/2015 Page 3 bf 3 APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER This form must "company zoning applications (Home Occupation, Zoning Clearance, Zoning Administrator Determinations or Appeals, Sign Permits, Building Permits) if the application is not the owner. I certify that notice of the application, Zoning Clearance Application _ [County application name and number] was provided to Sth Street Sta. , LLC [name(s) of the record owners of the parcel] and Parcel Number manner identified below: Hand delivering a copy of the application to the owner of record of Tax Map by delivering a copy of the application in the [Name of the record owner if the record owner is a person; if the owner of record is an entity, identify the recipient of the record and the recipient's title or office for that entity] on Date x Mailing a copy of the application to Jeff DeHart [Name of the record owner if the record owner is a person; if the owner of record is an entity, identify the recipient of the record and the recipient's title or office for that entity] on 7/14/2016 om to the following address: [address; written notice mailed to the owner at the last known address of the owner as shown on the current real estate tax assessment books or current Teal estate tax assessment records satisfies this requirement]. Signature of Applicant �CA Print Applicant Name 7/14/2016 Date