HomeMy WebLinkAboutCLE201700131 Application 2017-06-05Application forZoning Clearance
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OFFICE U Y
PLEASE REVIEW ALL 3 SHEETS
Check # Date: o)`
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: 076-MI-00-00-00200 Existing Zoning Planned Dev. Shopping Center
Parcel Owner:5th Street Station Ventures, LLC
Parcel Address:435 Merchant Walk Square, Ste. 300 City Charlottesville State VA Zip 22902
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? Terry Brown
Address :265 Turkeysag Trail, Ste. 102 City Palmyra State VA Zip 22963
Office Phone: 4( 34) 589-9602 Cell # 434-989-6620 Fax # E-mail mailboxexpress1029gmail.com
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name x New business
Business Name/Type: Mailbox Express, Packing and Shipping
Previous Business on this sitenone
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:
1,201 sf packing and shipping business
*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 ceni t at I own or have e o ner' rmission to se the space indicated on this application. 1 also certify that the information provided
is true and ac rate to t best my ow dge haver d the conditions of approval, and I understand them, and that I will abide by them.
Signature I/APrinted Kendra E. Guiffre, Architect
APPRO AL INFORMATION
Approved as proposed ] Approved with conditions [ Denied
Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-451 1, x 117.
[ ] No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
site plan.
[ J This site complies with the site plan as of this date.
Notes:
Building Official' Date
Zoning Official Date 1-51 2
-IleDate
Other Official
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 2ere 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 <3@ is water9
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 applies
Is parcel on septic o ublic sewer.
Y )/ N
ill 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, obtai r� V-r
tAA
Permit #
Zoning to complete the following:
Reviewerto complete the following:
Square footage of Use: /Z
i� / N
Permitted as: V► �-LS
Under Section:
Supplementary regulations section:
Parking formula: 5/s
Required spaces:
Y / NU
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
Y/ )
If so, List:
Proffers:
�/N
If so, List:
2A b/-
0
Varian e:
Y/ III
If so, List:
SP's-
Y/ V)
If so, List:
Clearances:
SDP's
2b 1-7 2�
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, County of Albemarle Building Permit# B2017-00627AC
[County application name and number]
was provided to Dan Tucker, 5th Street Station Ventures
[name(s) of the record owners of the parcel]
and Parcel Number
manner identified below:
Hand delivering a copy of the application to
the owner of record of Tax Map
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
EEJMailing a copy of the application to Dan Tucker, 5th Street Station Ventures
[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 05.26.17
Date
to the following address:
dan@sjcollinsent.com / 5 SW Broad Street, Suite B, Fairburn, GA 30213
[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].
Kendra E. Uuittre
Print Applicant Name
05.26.17
Date
300
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