HomeMy WebLinkAboutCLE201700112 Application 2017-06-05Application for Zoning Clearance
CLE # db 1-1-
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # Date: 11
Receipt # I iJ Staff: _ ,)
PARCEL INFORMATION �"�ry� -_
Tax Map and Parcel: J t IJ I 1 1 � — Existing Zoning PD-MC
Parcel Owner: 5th Street Station Ventures LLC
Parcel Address: ### Merchant Walk Square, Bldg, 800 City, State - Virginia Zip 22902
(include suite or floor) Charlottesvi
PRIMARY CONTACT
Who should we call/write concerning this project? Dan Tucker
Address : 5 SW Broad Street, Suite B City Fairburn State Georgia Zip 30213
Office Phone: 7( 70) 692-8300 Cell # (434) 245-4909 Fax # (770) 692-8302 E-mail danL@sjcollinsent.com
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name business
_ _x�New
Business Name/Type: Dollar Tree (Suite 800) / Mercantile
Previous Business on this site mostly undeveloped site
Describe the proposed business including use, number of employees, number of shifts, avalfable parking spnees, number of
vehicles, and any additional information that you can provide: This 10,179 square foot Dollar Tree (mercantile) business is
a Dollar Tree Store.
*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 Zouing
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 certil}, that the information provided
is true and accurate to the best of my knowledge. I have read the conditions of approval, and i understand them, and that I.vill abide by them.
�iL r `y / j
Signature �
F,• ..c.w�,...(':� �.� ` Printed_ t r-l�-fM � t-,�1 t_i..,1 A�` ('
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APPROVAL INFORMATION
C] Approved as proposed [ ) Approved with conditions [ ] Denied
[ J Backflow prevention device and/or current 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 Offlcial Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
Revised 7/1/2011 Page 2 of 3
Intake to complete the follo«ing:
Y
Is us n LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
1' / N
Wi 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 a .
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that appli
Is parcel on septic ublic sewers l
H' N
ill you be putting up anew sign of any kind? If so, obtain proper
Sign pernlit.
Permit #
/N
Y
ill there be any new construction or renovations?
If so, obt ' ti�e�r er Pernii
Permit #!
Zoning to complete the followin
Reviewer to complete the folloNiing:
Square footage of Use:
0/ N
Permitted as:
Under Section: 2SA.2
Supplementary regulations section:
Parking formula:
Required spaces:
Y / (9 b
Items to be verified in the field:
Inspector : Date:
Notes:
Viola 'ons:
Y /W
If so, List:
P�4 ffers:
V/ N
If so, List:
Variance:
Y/N
If so, List:
SP's:__\\
Y
If so, List:
Clearances:
SDP's
SbP 2011 —�
Revised 7/1/2011 Page 3 of
L L