HomeMy WebLinkAboutCLE201200187 Legacy Document 2012-10-12U,
Application for Zoning Clearance
CLE #
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PLEASE REVIEW ALL 3 SHEETS
OFFICE S ONLY
Check Date:
Receipt # Staff:,/ i
PARCEL INFORMATION
Tax Map and Parcel: 07800— •00 -00 -5500 Existing Zoning,��1/`�C./
Parcel Owner: Luxor Office Park, LLC
Parcel Address. 1430 Rolkin Court, Suite Charlottesvil; &te VA Zip 22911
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? Denise E LaCour
1430 Rolkin Court, Suite #301 Charlottesville VA 22911
Address: City State Zip
Office Phone: (434 971 8996 Cell# 434 981- 470�ax# 434 971- 934L4_inail Denise @denico.net
APPLICANT INFORMATION
any that apply: Change of ownership Change of use Change of name New business
-Cheek
Business Name /Type: Floriss, Inc. / Management — Consulting
Previous Business on this site Not Applicable — new construction
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 ovm or have the owner's permission to use die space indicated on this application. I also certify that the information provided
is true and ac Zite t o the best of my laiowledge. I h�ac�ead the conditions of approval, and I understand them, and that I will abide by them.
Signature ( � /!// Printed
APP INFORMATION
[ pproved as proposed [ ] Approved with conditions [ ] Denied
[ ] Bacicilow 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 dale.
Notes:
Building Official Date f C t
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 7/1/2011 Page 2 of 3
Litake to complete the following:
Y /Q)
Is use in LI, I -11 or PDIP zoning? If so, give applicant a Certified
L'ngincer's Report (C.ER) packet.
Y/Otierc Wil 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 of =ivaiteir?
I1'privatc well, provide Health Department form.
Zoning review can not begin until we receive approval from IIealth
Dept. FAX DATE
Circle the one that apE��)
Is parcel on septic of
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Will'y�ou 1be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y N
� 1 there 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: 406
6/N
Permitted as: U�; �,� CAS Q_1
Under Section: 2Sfj . Z- - I
Supplementary regulations section:
Parking formula:
Required spaces: ✓y/
Y/N
Items to be verified in the field:
Inspector:
Notes:
Date:
olations:
/N
If so, List:
'roffcrs:
("/N
f so, List:
Val- iallee:
Y 1(N
If so, List:
SP'S:
(�)/ N
If so, List:
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05-- �.
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3