HomeMy WebLinkAboutCLE200800089 Legacy Document 2013-01-11Application for
Zoning Clearance
OFFICE USE ONLY (� G
Zoning Clearance = $35 CLE # ®%7 r7 ma
PLEASE REVIEW ALL 3 SHEETS Check # t .,W,a,4 Date: f/' Z.Z -p
Receipt # to�g R( K Staff:
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PARCEL INFORMATION
Tax Map and Parcel: Tax Map 78 - Parce 1 20F - -PZTrE "= Existing Zoning Commerc i a 1
Parcel Owner: State Farm Mutual Insurance Company
Parcel Address: 1500 State Farm Blvd. City CharlottesviIle State VA Zip22909
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? Tim Johnson
Address: 1500 State Farm Blvd. Cit3Charlottesville
State VA
Zip22909
Office Phone: 4( 34) 872 -6038 Cell #906 -3325 Fax# 872 -5713 E- mailtim.johnson.grna @statefar
G � Lll-, A4
APPLICANT INFORMATION
BusinessName/Type: State Farm Mutual Insurance Company --
Previous Business on this
Describe the proposed business, including use, number of employees, number of shifts, available parking
additional information that you can provide: See Attached
and any
*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, anew 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 gfj i y knowledge.) have read the conditions of approval, and I understand them, and that I will abide by them.
Signature '1 /9�� � Printed M&A Im M / w75' -C./
APPROVAL INFORMATION
[ ] Approved as proposed roved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, x119.
[ ] 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 co lies with the a plan as of this d t .
Notes: ������ k (!l vz) 67 A('iP h Y41I z—' 6 n t-%b ✓i.d c.2? G�-ia /o !tea ✓�c�Q
Building Official Date `{,'�
Zoning Official Date S' / 6
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
511106 Page 2 of 3
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Intake to complete the following:
❑ YES [4O
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
F-1 YES EjN
Will there 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
❑ YES ❑ NO
Is parcel on private well or,��public��water?
If private well, provide Healt�partment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
❑ YES ❑ NO
Is parcel on septic or public sewer?
❑ YES [ 'No
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
❑ YES NO
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
ZoninLy Tech to complete the following:
Reviewer to complete
Square footage of Use: r j c
K YES F-1 o
ermitted as: 1/
Under Section: YaZ 1(�
Supplementary regulation section:
- d
Parking formul
Required spaces:
F-1 YES F-1 NO
Items to be verified in the field:
Viola 'ons:
❑ YE NO
If so, List:
Proffers:
❑ YES [I NO
If so, List:
Variance:
❑ YES ❑ NO
If so, List: .1'so,
-sP'
❑ NO
List:
5/1/06 Page 3 of 3