HomeMy WebLinkAboutCLE201900033 Action Letter 2019-02-27Application for Zonin Clearance
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OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS
Check # L L I Date:
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: 061 WO-0 1 -OA-009AO Existing Zoning C-1
Parcel Owner: Commonwealth Business Center, LLC
Parcel Address: 2300 Commonwealth Dr, Ste. 202 City Charlottesville State VA Zip 22901
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? Sue A. Albrecht
Address : 80 Roslyn Forest Lane City Charlottesville State VA Zip 22901
Office Phone: 4( 34) 531-2435 Cell # 434-531-2435 Fax # 434-973-0732 E-mail sue@designenvirons.com
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: Dustin Medley Insurance Agency, LLC
Previous Business on this site Hands of Favor, LLC
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:
Insurance Sales
*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 th own or av e o 's permission use the space indicated on this application. I also certify that the information provided
is tru acc to the st my o ge. I have the conditions of approva and I understand them, and that I will abide by them.
Sign tur Printed i
APPROVAL INFORMATION
�Q Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] 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 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 /�
Is use m LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /�N
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 or ublic water.;.
If private well, provide Heal Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that apples _ �`
Is parcel on septic o pubf lic sewer
Y /
Will ou be putting up a new sign of any kind?
Sign permit.
Permit #
If so, obtain proper
Y /rWill ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: - 1 lJ
Y/N 0f�Ce-
Permitted as: (
Under Section: Zl= Z . I
Supplementary regulations section: I v 10
Parking formula: I (Zoo A C F
Required spaces: I
Y/
Ite be verified in the field:
Inspector•
Notes:
Date:
Viola ' ns:
Y/�
If s ist:
A /�
Proff s:
Y
If soo, f ist:
00 /le
riance:
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so, List:
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SP's:
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If so, ist:
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Clearances:
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SDP's
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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, Sue A. Albrecht
[County application name and number]
was provided to Sue A. Albrecht
[name(s) of the record owners of the parcel]
and Parcel Number 061 WO-01-OA-009A0
manner identified below:
the owner of record of Tax Map
by delivering a copy of the application in the
0 Hand delivering a copy of the application to Commonwealth Business Center, LLC, S. Albrecht, Mc
[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 .2- tt -19
Date
Q Mailing a copy of the application to
[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
to the following address:
[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 r1al,gstate tax assesrds satisfies
this requirement].
rint pplicant Namec
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OJECT r'WAE: f�SIGN ENVIRON, CORPORAT��;%—''
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COMMONWEALIN MNESS CCH ME 11E60,NUII 111I.LT F1111,116JI50 I.N--
DATE; BY,
BY,
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SUar- 202 Ian
10 OF MAN LLC
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CHR6TEN FORIMULLER
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CHARL OTTESVII-LE, VA
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