HomeMy WebLinkAboutCLE201900123 Action Letter 2019-06-06Application for ZoninE Clearance
CLE #
OFFICE U 1
PLEASE REVIEW ALL 3 SHEETS
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Check # Date: I
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Receipt # • Staff:
PARCEL INFORMATIONV.
Tax Map and Parcel: 07800-00-00-031 JO Existing Zoning PDMC
Parcel Owner: PJP Building Six, LC
Parcel Address: 650 Peter Jefferson Pkwy, Suite 106 City Charlottesville State VA Zip 22911
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? Robin Kay, CRE Business Analyst
Address: 3300 Mutual of Omaha Plaza City Omaha State NE Zip 68175
Office Phone: (402) 351-2152 Cell # Fax # E-mail creadmin@mutualofomaha.com
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name X New business
Business Name/Type: Mutual of Omaha Insurance
Previous Business on this site '—� tr L'N� b f Lr�
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:
*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 accurate to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
42.1
Signature _ Printed Robin Kay
APPROVAL INFORMATION
�Q 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 Ate' AA, 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 us n LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
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 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 applie
Is parcel on septic or pobtse r?
Y 16)
Will you be putting up a new sign of any kind?
Sign permit.
Permit #
If so, obtain proper
Y/N
ill there be any new construction or renovations?
If obtain grope ,Permit ,. 911 A
Permit
ID # � C.
Zonine to complete the following:
Reviewer to complete tke following:
lU� 3 3 8
Square footage of Use:
.rm tt Pded as: AAM c n , f s I U'1Gt pM cf-.-
Under Section: 25 a. Z.. I -,"� ZZ , Z
Supplementary regulations section: �q,A,
�jd
Parking formula: SD n ! � •�c)o
Required spaces:
SQa[ Lef
Y /
Items to be veri ied in the field:
50 V S t,ow s sc/(� C,9e k
Inspector•
Notes:
Date:
violations:
If sst:
YB,ii
N�� Ap�(���(�
Proff s:
Y/�
If so, ist:
Mope
Vari ce:
Y /
If so , ist:
rUo�,e
's.
s
so, List:
fUo�e �PQI � ca 6 (Q
Clearances:
SDP's
S p P .2- c j I R11)
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50 L) ► 3 3
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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.
, 0111 - d ) Z� � �L ti �� o o n� Art
I certify that notice of the application,
[County application name and number]
was provided to ` X L the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number ()� Yo " oo - Co 5l li by delivering a copy of the application in the
manner identified below:
Hand delivering 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
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 sr3 / to the following address:
Date
3bD P4,60ak;5 vlYv1 Pt._ S.;t 330 ��-�► l f UZ3 G
[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].
Signature of Applicant
Print Applicant Name
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Date
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