HomeMy WebLinkAboutCLE201400168 Legacy Document 2014-09-04Application for Zo nin Clearance
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CLE # -2CI L4
OFFICE USE ONLY
0612-C 1 V
PLEASE REVIEW ALL 3 SHEETS
Check # $5 Date:
Staff:
Receipt #
PARCEL INFORMATION
Tax Map and Parcel: 78 -15C9 Existing Zoning HC
Parcel Owner:
Pat-eel Address: 172 S Pantops Drive, Ste B - City. Charlottesville -State Virginia Zip 22911
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? Shana Kirby
Address: 172 S Pantorm Drhv .. St . B City Charlott .swill . State Virginia Zip 22911
Office Phone: 434 977 -7771 Cell # Fax # 971 -9747 E -mail skirby@willscpas.com
APPLICANT INFORMATION
Check any that apply: X Change of ownership Change of use X Change of name New business
Business Name/Type: Wills
Previous Business on this site Dominion Engineerina & Desion I I C --
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: Arcot nting Firm 12 employees 1 shift 22 12arkinq snarac
10 vehicles for em I
*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 tt1hat I will abide by them.
Signature Printed ^ • /
APPROVAL INFORMATION
t 7 4 nnrCyed with conditions [ ]Denied
Approved as proposed L J • -rr•
[ ] Backflow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, xi.i7.
[ ] No physical site inspection has been done for this clearance. Therefore, it is not a determination of coin pIiance with the existing
site plan. • •
[ ] This site complies with the site plan as of this date.
Notes:
f r
�— Da to
Building Official
Date
Zoning Official
Othea• Official Date
County of Awemarie ueparaueuL w ♦.utuu1uuu.y ._• ...
401 McIntire Road Clio NottesviIle, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 7/1/2011 Page 2 of 3
OM
Intake to complete the following:
Y/b
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /�
Will there be foot! 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 is water?
If private well, provide Heath. artmetit form.
Zoning review can not begin until we receive approval from Health
Dept, FAX DATE
Circle the one that applies
Is parcel on septic or p ,lr sewe
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the
Violations:
If o, List:
Variance:
Y/I�
If so� st:
Clearances:
Reviewer to complete the following:
Square footage of Use: ;7—
it / N.
Permitted as: 0 T csz�
Under Section `t '2
Supplementary regulations section:
Parking formula:
L v l)
Required spaces:
Y/
Items to bq verified in the field:
Inspector : Date:
Notes:
Proffers:
(fe�
If so,-List:
SP's:
'
]f sd; Dist:
SDP's
Revised 7/1/2011 Page 3 of 3
V 0
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, Application for Zoning Clearance
[County application name and number]
was provided to Baliff Investments, LLC the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number 78 -15C9 _ by delivering a copy of the application in the
manner identified below:
X Hand delivering a copy of the application to Baliff Investments LLC
[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 August 25 2014
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 to the following address:
Date
[address; written notice mailed to the owner at the Iast 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].
of •
Stapleton W Wills CPA
Print Applicant Name
/u
Date
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