HomeMy WebLinkAboutCLE201700006 Application 2017-01-20Application for Zoning Clearance_�`p
CLE # _
OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS
Check # Z -� Date: VJ 1
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: 06100-00-00-123HO Existing Zoning Highway Commercial
Parcel Owner: 29 Rio XRoad, LLC
Parcel Address: 1700 Seminole TRL City Charlottesville State Virginia Zip 22901
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? Rebkee Company
Address : 15871 City View Drive, Suite 300 City Midlothian State VA Zip 23113
Office Phone: (804) 419-0747 Cell # 804-387-4449 Fax # 804-419-0759 E-mail psprouse@rebkee.com
APPLICANT INFORMATION CVS 10746 VA, L.L.C.
Check any that apply: Change of ownership ange of use Change of name New business
Business Name/Type: CVS Pharmacy/Pharmacy
Previous Business on this site Bank and various retail shops
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
CVS is
vehicles, and any additional information that you can provide: a retail drug store with approximatel
_18 employees (7 FT/I1 PT); shifts vary w/FT working 8H shifts and PT working 4H shifts. There will be 57 available parkin
_spaces w/on average, 8 being taken by employees.
*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 accurat 6 the b t of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed Paul Sprouse
APPROVAL 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 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) 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 /
Will te 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 p =tpent
r?
If private well, provide Health form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applie
Is parcel on septic or ublic se
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
6)/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit # .2=6 IL — � s % A)U
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: / 9 L/
6 / N
Permitted as: I
Under Section: �L� . y
Supplementary regulations section:
Parking formula:
1
�l,/
Required spaces:
C
Item to be verified in the field:
Inspector :
Notes:
Date:
Violat' ns:
Y/(!)
If so, List:
Proffers:
Y/
If so, ist:
Varia e:
Y / I
If so, List:
's:
Y / N
f so, List:
Clearances:
SDP's
Revised 11/1/2015 Page 3 of 3
CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
This form must accompany 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, Application for Zoning Clearance
[County application name and number]
was provided to 29 Rio XRoad, LLC the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number 06100-00-00-123HO
manner identified below:
Hand delivering a copy of the application to
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
0 Mailing a copy of the application to Coran
[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 December 22, 2016 to the following address:
Date
455 Second Street SE, 5th Floor, Charlottesville, VA 22902
[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 real estate tax assessment records satisfies
this requirement].
C�
Signa re f Applicant
CVS 10746 VA, L.L.C.
Print Applicant Name
December 22, 2016
Date