HomeMy WebLinkAboutCLE201600260 Application 2016-11-22Application for Zoning Clearance
C L E # a I U J U'C
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OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS
Check #
Receipt # raVfi�
PARCEL INFORMATION
Tax Map and Parcel: 78-17D6 Existing Zoning
Parcel Owner: Woodward Properties
Parcel Address: 260 S. Pantops Drive City Charlottesville State VA Zip 22911
(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 Tree lot apd wks zoro employees, 10, 12yal untonrs
*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 of my kn . I have read the conditions of approval, and 1 understand them, and that I will abide by them.
Ve"71,
Signature Printed Scott M. Lancey
APPROVAL INFORMATION
-tp,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 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
L
Zoning Official Date 4
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 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 or w r?
If private well, provide Hea artment 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 c se er?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoniniz to complete the following:
Reviewer to complete the following:
Square footage of Use: 150 b
(V/ N )
Permitted as: SG4��yy,�l/e S
Under Section: 'Al DrAc 'CC
Supplementary regulations section:
Parking formula:
Required spaces:
Y /
Items o be verified in the field:
Inspector Date-
Notes:
Viola ' ns:
Y/1v
If so, List:
Proffers:
N
If so, List: Z
Variance:
6 / N
If so, List: s�
9I
SP's•\\
Y/15U
If so, List:
Clearances:
SDP's
Revised 11/l/2015 Page 3 of 3