HomeMy WebLinkAboutCLE201400194 Legacy Document 2014-10-08E�M[1211 P]
Application for Zoning Clearance
-
PLEASE REVIEW ALL 3 SHEETS
OFFICE US + QNLY
Check #� Date ;
Receipt It Staff: Jl Q
PARCEL INFORMATION
Tax Map and Parcel: 32-6A 460 ACRES Existing Zoning PDIP
Parcel Owner: UNIVERSITY OF VIRGINIA FOUNDATION
Parcel Address: LEWIS AND CLARK DRIVE City CHARLOTTESVILLE State VA Zip 22811
(include suite or floor)
PRIMARY CONTACT j��pp
Who should we call /write concerning this project? al �h tv a 44 nee,
Jy�
Address: ���@ qff� t° f � (k �� Ciityy( 1 , p&1 �1 State `4� f Zip
Office Phone: (� ~l��Cell #�����. +ax #�D�� tQ'�° -mail ��� DY9• ld �'� �t�
APPLICANT INFORMATION
Check any that apply: Change of ownership Changel of use Change of name New business
t �
Business Name /Type: N�l11 6 a n 'l°`%tapA s oci a pion ti.w't' Wo'k
Previous Business on this site MV\ e' S m o V l�Ql�l� ke s eaf & \ 94(y— f (e n i
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: l�9] i� r�
A'Al'a ( V i G V e,h3 t bts+-'�'
`This Clearance will only be valid on flee parcel for which it is approved. If you change, intensify or move the use to a new location, a newZoning
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 oAurate to the P" of my knowledge. I have read the conditions of approval, and I understand and that I will abide by them.
ythem,
Signature �1 Printed —ak Ve _T , �1®y_
i
APPR AL INFOMATION
[ )proved as pt•Dposed [ ] 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 forthis clearance. Therefore, it is not a determination of compliance with the existing
site plan.
[ ] This site complies with-tile site plan as o(ffthis dater
Notes- ,b(R4A.A0A`
Building Official Date ('D
Zoning Official Date(
-A..; U
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/l/2011 Page of
Intake to complete the following:
P/
s use N in LI, 1.11 or PDIP'zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y/N
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
Circle the one that applies
is parcel on private well oz ublic water
if private well, provide Healt 1 epartment 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 ublic sewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y 0erWilll ere be any netiv construction or renovations?
If so, obtain the proper Permit.
Permit it
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use:
/N ���
ermitted as: � _�_ vx %& 6v e-,
Under Section: 9rA a��
Supplementary regulations section:
Parking formula:
Required ad Items to be in the field:
Inspector: Date:
Notes:
Violations:
Y/N
If so, List:
Proffers:
Y/N
If so, List:
Variance:
Y/N
if so, List:
SP's:
Y/N
If so, List:
CIearances:
SDP's
Revised 7/1/2011 Page 3 of
CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
This form must accompany zoning applications (Horne Occupation, Zoning Clearance, Zoning
Administrator Determinations or Appeals, Sign Permits; Building Permits) if the application is not the
otvrrer.
I certify that notice of the application,
[County application name and number]
was provided to U VA FOUNDATION the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number 32 -6A 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
X Mailing a copy of the application to JIM WILSON, SENIOR ASSET MANAGER
[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
PO BOX 400218, CHARLOTTESVILLE, VA 22904
[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].
Si flure of Appli
L (- (�
Print Ap licai t Nam e
S
Date
N
a
1_
�� 1�sY Gib '•' ',.p
QJ•• sp.@ ±±-��e3 C11Sg3gL�z � ~•;: i.;:::::" 9
/ o �PSgP tz)
Nk
tint
Q •,., ` `� +`{{ `5.� ..� � Z.� " „-.✓ ,Ei tit �'
i • �y�p.,•r �j/� P� {Ji ��4� Qy�s � / ray' � /w::z'�Q- /
p�.bnsi OR, RFC V .
co 1 EIL
co
i `�✓ eOQ11Y tJ ' !C O
cr
coi+` ,r
09 -
VIV-
a
2
CL
UU
40
IF'0*
06 VP S
00.
go
ig
R
ye All
CD
OR
a.
..................
a
2
CL
UU
40
IF'0*
06 VP S
00.
go
ig
R
ye All
CD