HomeMy WebLinkAboutCLE201500050 Legacy Document 2015-03-26Application for Zoning Clearance1.
CLE # ZO 15 - 5 O
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check# gcl7 3 Date: 3 21,o
Receipt # 0 q'16 43 Staff.
PARCEL INFORMATIION
L+6— 1 (Dq C 2 Existing Zoning
Tax Map and Parcel:
Parcel Owner: All' t S% U' 1 P��,,$ L-L C
Parcel Address: 3315 Berkmar Drive Ste 2-D City Charlottesville State VA Zip 22102
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? Joyce Chapman
Address: Electronic Systems, 369 Edwin Drive City Virginia Beach State VA Zip 23462
Office Phone: (Z57) 217-1262 Cell # 757-217-6892 Fax # 757-518-2604 E-mail joycec@esi.net
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name X New business
Business Name/Type: Office Technology Equipment Reseller - sales and service office
Previous Business on this site Unknown
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:
3-5 Sales Employees, 1-2 service Employees - Day shift only M-F, 3-5 parking spaces, 3-5 vehicles.
*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 Printed N. Joyce Chapman
APPROVAL INFORMATION
Approved as proposed [ ] 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 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 date.
Notes:
Building Official Date 3 (t J
Zoning Official Date
Other Official Date
County of Albemarle Pepartment of k-ommumty Leve►opmeur
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
Revised 7/1/2011 Page 2 of 3
Intake to complete the following:
Y/N
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
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 or public 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 or public sewer?
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 #
7.nnina to PmmnlPtP the fnllnwincr'
Reviewer to complete the following:
Square footage of Use: (�
�/N ]
ermitted as:
Under Section: Z2-•2->
Supplementary regulations section:
Parking formula:
Required spaces: / Z
Y/
Items o be verified in the field:
Inspector:
Notes:
Date:
Viol(attiions:
If o;-,ist:
Profers:
If so',' -fist:
Varian' :
Y /
If so, ist:
SP's: —\
Y
If so, List:
Clearances:
SDP's
x c��
Revised 7/1/2011 Page 3 of 3
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,
[County application name and number]
was provided to ke e S -n, r ." I- 9 L�— C - the owner of record of Tax Map
[name(s) of the re co d owners of the parcel]
and Parcel Number
manner identified below:
by delivering a copy of the application in the
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
i/ Mailing a copy of the application to I4C Cess P -(a -9\0-d-095
[Name of the record owngr 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
aba
to the following address:
a�sti�CC�, Ube Qq%s/
[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].
-Ypov�
SignatureVof pplicant
/U-
Print Applicarit Name
Date
D
�
OCATION: Cedars Court 1st Floor Phase I
DATE: December 17, 2009
�urrent Layout
Piedmont Facilities Management
[.FM.ICI,cntS/HasbroUCkICedars Ct/091217COdarsCti.-IFloor