HomeMy WebLinkAboutCLE201600261 Application 2016-11-22Application for Zoning Clearancey
CLE #
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY o
Check#
Receipt #
PARCEL INFORMATION
Tax Map and Parcel: 56A2-01-29 Existing Zoning
Parcel Owner: Crozet Shopping Center, LLC
Parcel Address: 5734 Three Notch'd Rd City Crozet State VA Zip 22932
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? Scott Lancey
Address: 1545 Shady Forest Way City Charlottesville State VA Zip 22901
Office Phone: (434) 964-0880 Cell # 540-461-2171 Fax # 434-234-0241 E-mail scott.lancey@scouting.org
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: Boy Scouts of America/Non-Profit Youth Organization
Previous Business on this 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:
Christmas True- "otapalraekr,, zero ampleysees, 10-12ya-h-intears
*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 that the information provided
is true and accurate to the best ofA knowledge- I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature C '" Printed Scott M. Lancey
APPROVAL INFORMATION
Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Bacldlow prevention device and/or cu ent test data needed for this site. Contact ACSA, 9774511, 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 of this date.
Notes:
Building Official Date
Zoning Official Date
Other Official 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/N
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 o ublic er?
If private well, provide He nt form
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that
Is parcel on septic ublic sew .
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:
''/N
Permitted as:
Under Section: .41-m i tv R%, f;i LL.
Supplementary regulations section:
Parking formula:
Required yes: Z.�
Y/
It o be verified in the field:
Inspector: Date:
Notes:
Vio coons:
Y/N9
If so, List:
Prod
Y/
If so, List:
Vari ce:
Y/I
If so, List:
SP's:
& / N
If so, List: �S/
D7
Clearances:
SDP's
0-
Revised 11/l/2015 Page 3 of 3