HomeMy WebLinkAboutCLE201500066 Application 2015-05-07Application for Zoning Clearance°
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # J169 10 Date: L% ) b I
Receipt # 49 4 G, q Staff:
PARCEL INFORMATION
Tax Map and Parcel: 061 YO -00 -OB -20200 Existing Zoning NMD
Parcel Owner: J L S Properties LLC
Parcel Address: 943 Glenwood Station Lane City Charlottesville State VA Zip 22901
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? LINDSAY O'NEILL
Address: 4100 S. HULEN STREET City FORT WORTH State TEXAS Zip 76109
Office Phone:8( 17) 569-2351 Cell # Fax # E-mail cloneill@firstcommand.com
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name X New business
Business Name/Type: First Command Financial Services, Inc. - Financial Services Holding Company
Previous Business on this site Judy Savage Realty
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:
Financial Planning & Insurance 1 employee
*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 oof�f**��my owledg`e have read the conditions of approval, and I understand them, and that I will abide by them.
Signature `k PrintedJOEY A. STORASKA
APPROVAL INIOkAATION
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
Zoning Official Date
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 7/1/2011 Page 2 of 3
Intake to complete the following:
Y /,N�
Is us n LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y / (/K
WX4;ere 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 r publi ater?
If private well, provide H epartment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one thatpplies
Is parcel on septic ubli er?
Y/N
Will you be putting up a new sign of any kind?
Sign permit.
Permit #
If so, obtain proper
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: 5 p i�
6/N
Permitted as: ��' Cs/
Under Section:e-7X1OG��ri U •
Supplementary regulations section:
Parking formula:
CJD
Required spaces:
Y /
Items to be verified in the field:
Inspector :
Notes:
Date:
Viola, ions:
Y/
If so, ist:
Proffers:
6/N
If so, List:
Vari ce:
Y/
If so, ist:
SP's:
Y/
If so, List:
Clearances:
SDP's
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 cJ LS J? (D PPA L -Lc— the owner of record of Tax Map
[name(s) o the record owners of the parcel]
and Parcel Number 0 (Q 14 0 -00 "06 —appjWby 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
Mailing a copy of the application to ((tiLS UC- u,
[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 3 — CQ fo - a O 15 to the following address:
Date
[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].
Sign tt e Applicant
JOEY A. STORASKA
Print Applicant Name
03-26-2015
Date
CAwcdd
02
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