HomeMy WebLinkAboutCLE200900188 Legacy Document 2012-10-15Application for Zoniinff Clearance
CLE # F -' U BUILDING PERMIT #„
B2009- 1324AC
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PARCEL INFORMATION
Tax Map and Parcel: 03200- 00- 00 -006AO Existing Zoning PDIP
UVA Foundation
Parcel Owner:
Parcel Address: 995 Research Park Blvd., Suite 100 City Charlottesville State VA
Zip 22911
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? Mike Stumbaugh
Address : P.O. Box 400218 City Charlottesville State VA
Zip 22904
Office Phone: 4( 34) 982 -3777 Cell # (434) 531 -1938 Fax # (434) 982 -4852 E -mail stum @virginia.edu
APPLICANT INFORMATION
Business Name/Type: Mitre Corporation
Previous Business on this site None
Describe the proposed business including use, number of employees. number of shifts. available narking spaces. number of
vehicles, and any additional information that you can provide: _ Office / Wet Lab; approximately 8 =10 employees. -
*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.
Signature /A I \ =m Printed
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401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 04/28/08 Page 2 of 3
Intake to complete the following:
J/ N
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y nN
WiTFrere 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 ublic water?
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 �r?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
J/ N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit # 62009 -1 S24AC
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use:
Y)/ N
Pe miffed as: p�.I�1C� /r PGA
Under Section: —�4
Supplementary re gu ations section:
1S
Parking formula:
/moo o VO,
Required spaces:q
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
Viol ns:
Y /(�
If so, List:
P /
/ N
so, List:
Varia ce:
Y/L
If so, List:
S 's:
/N
f so, List:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3