HomeMy WebLinkAboutCLE201700053 Application 2017-04-12Application for Zyy oning Clearance
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CLE # i��� 1.-,
-�/RCINIP'F
OFFICE U ONLY
PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: 78-9C Existing Zoning HC-EC
Parcel Owner: TAP Investments, LLC
Parcel Address: 930 Olympia Drive - 108 Citv Charlottesville State VA Zip 22911
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? Bob Pingry
Address : 2903 North Augusta Street City Staunton State VA Zip 24401
Office Phone: () Cell # 434-981-5094 Fax # E-mail bobpingry@gmail.com
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name X New business
Business Name/Type: T-Mobile / retail store for mobil phone sales and account servicing
Previous Business on this site none
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:
retail sales and display of mobile phones. Five employees max at this time. 10 AM-8 PM M-Sat, 12PM-6PM
Sundays. Parkinq demand will be 8 +/-
*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 t o or , h owner's permission t e the space indicated on this application. I also certify that the information provided
is true and acc to e b t n knowledge. I 1 read the conditions of approval, and 1 understand them, and that I will abide by them.
Signature Printed /Ten of
APPJk0VAL INFORMATION
[VkApproved as proposed [ J Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-451 1, 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:
WIN
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
Will ere 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 public water'?
If private well, provide Hea epartment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that ap
Is parcel on septic or(public sewer?
'Y/N
2ill you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
N
� l there be any new construction or renovations?
If so, obt e op e n t�
Permit #�
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: I KI
/N
as:
Under Section:
Supplementary regulations section:
G'
1,� z
Parking formula: ON-VAVLS
C r
Required spaces: i
It /VIten be verified in the field:
Violations:
Y/N
If so, List:
Proff
Y/(0
If SO, -List:
Var' e:
Y/N
If so, st:
SP's:
Y/V
If so, ist:
Clearances:
(YUCA
SDP's
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4� V
Revised 1 1/1/2015 Page 3 of 3
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