HomeMy WebLinkAboutCLE201500256 Application 2015-12-08Application for Zoning Clearance CLE # nO 1 � -� Q S-� is
OFFICE USE ONLY /
PLEASE REVIEW ALL 3 SHEETS Check # G ) d G Date: Gk r%1 S
Receipt # ! cy a L4 � Staff:
PARCEL INFORMATION
Tax Map and Parcel: 46134-1 A2 Existing Zonin_gHC
Parcel OWner:ADI Properties LLC
Parcel Address: 1758 Worth Park City Charlottesville State VA Zip 22919
(include suite or floor)
PRIMARY CONTACT
Who should we cal]/write concerning this project? Carol Tomanelli, Richard J. Menfi CPA
Address :72 South Maple Avenue City Ridgewood State NJ Zip 07450
Office Phone:2( 01) 670-0643 Cell # Fax # 201-670-0330 E-mail carol@rjmenficpa.com
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name x New business
Business Name/Type: Silicom Connectivity Solutions, Inc.
Previous Business on this siteADI Engineering Inc.
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:
business office, 18 employees, 1 shift, approximately>6 parking spaces, 2 story building totaling 8000 square feet
fy
*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 �� ��(' A Printed Richard J. Menf CPA
APPROVAL INFORMATION
] Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 9774511, xl 17.
[ ] 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 'A �~ Date i 'Z6_
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 11/02/2015 Page 2 of 3
Intake to complete the following:
Y /(9
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
Y l&
If so, give applicant a Certified
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 p rc wa ?
If private well, provide Heal artment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that ap
Is parcel on septic or ublic se r?
YIN
Will you be putting up a new sign of any kind?
Sign permit.
Permit #
If so, obtain proper
YIN
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zonin2 to complete the followin :
Reviewer to complete the following:
Square footage of Use: f d o a
0/N
Permitted as: L.Q. 1A3`—
Under Section: Z V • Z • I
Supplementary regulations section:
Parking formula- /jJls�e
Required spaces: 3'2 --
,2 --IItems
tems to be verified in the field:
Inspector : Date:
Notes:
Violations:
Y/&
If so, List:
Proffers:
Y
If solList:
Variance:
Y/6
If so, List:
y
If so, ist:
Clear2nces:
SDP's
Revised 11/1/2015 Page 3 of 3
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