HomeMy WebLinkAboutCLE201500171 Application 2015-09-03Application for Zoning Clearance
CLE # ` k \'S- -1-1 1
OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS Check # IC11 I'S Date: $ l t
Receipt # ) n) pp -1 Staff:
PARCEL INFORMATION
Tax Map and Parcel: 061ZO-03-00-205BO
Parcel Owner: Contrails LLC
Parcel Address: 1410 Incarnation Dr., Suite 2058
(include suite or floor)
Existing Zoning Planned Unit Development
City Charlottesville
PRIMARY CONTACT
Who should we call/write concerning this project? Tony Valente
Address :1410 Incarnation Dr., Suite 205B
Office Phone: (_434) 825-9040 Cell # 825-9040
APPLICANT INFORMATION
City Charlottesville
Fax #
State VA
Zip 22901
State VA Zip 22901
E-mail tonyvalente@comcast.net
Check any that apply: Change of ownership Change of use Change of name X New business
Business Name/Type: Emax Oil Company
Previous Business on this site Albemarle Arthritis Associates
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:
small administrative office, one part time employee, half days - -2 veNc es, + available parking spaces
*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 accurf my kno ledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
rK
Signature V U Printed Anthony A. Valente
AIVAL INFORMATION
Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Ugftflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, x117.
ft4No 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.
Building Official
Date
Zoning Official VDate
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 2 of 3
Intake to complete the following:
Y
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y
Wil]t sere 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 uo c�watex2---
Il'private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that a
Is parcel on sep ' or public sewer?)
Reviewer to complete the following: �
Square footage of Use:
-Permitted as:
Under Section:
Supplementary regulations section:
=Parkingmula: a,%
Req . d spaces:
Y N
It be verified in the field:
Y
WilldN�
a putting up a new sign of any kind? If so, obtain proper
Sign permit.
Inspector : Date:
Permit #
Y
Notes:
WIsere be any new construction or renovations?
If so, obtain the proper Permit.
Permit t#
Zoning to complete the following:
Violations:
offers:
YIN
/N
If so, List:
f so, List:��
Variance:
SP's:
Y/N
Y/N
If so, List:
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 t1je application is not the
owner.
I certify that notice of the application;
was provided to
[County application name and number]
[name(s) of the record owners of the parcel]
and Parcel Number
manner identified below:
the owner of record of Tax Map
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
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
Date
to the following address:
[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].
Signature of Applicant
Print Applicant Name
Date
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