HomeMy WebLinkAboutCLE201500254 Application 2015-12-08Application for Zoning! Clearance lo—
OFFICE
CLE #1
U E ONLY a _
PLEASE REVIEW ALL 3 SHEETS Cheek# ,' tri Date: �5
Receipt # PyA <-p /P= Staff:
PARCEL INFORMATION
Tax Map and Parcel: 061X1-00-26-00100 Existing Zoning Commercial Business/Retailing
Parcel Owner: William R Carriker
Parcel Address: 355 Rio Road West, Suite 101 City Charlottesville State VA Zip 22901
(include suite or floor)
PRIMARY CONTACT
Who should we calVwrite concerning this project? Bruce Carriker
Address: 355 Rio Road West �,� " O 1 City Charlottesville State VA Zip 22901
Office Phone: (434) 974-6310 Cell # 434 825-0818 Fax # E-mail bearriker@appliedvi.com
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name X New business
Business NamelType: Applied Video Imaging, LLC - Aerospace and Defence video products
Previous Business on this site Church
Describe the proposed business including use, number of employees, number of shifts, available p rking spaces, number of
vehicles, and any additional information that you can provide: • S ` ' `
*This Clearance will only be valid on th 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 m wledge. I e read the conditions of approval, and I understand then, and that I will abide by them.
Signature 6 Printed (L652--
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 I7.
[ ] 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:
�r
Building Official Date -W
Zoning Official Date .o
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
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report {CER} packet.
Y l
Wil 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 or pu w
If private well, provide Health Dep ent 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 ubfic sew ?
/N
ill 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 #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: f o
(!0 / N r�,,
Permitted as: �� ,-m j,�y /1nAA11 i ACfQY)
Under Section: 2v
Supplementary regulations section:
46' +
Parking formula:
Required spaces:
YI
Items to be verified in the field:
Inspector • Date:
Notes:
Viol ons:
Y/"1
If so, List:
Proffe :
Y/
If so, List:
Varig ce:
Y /(Y
If so, List:
SP's:
Y /()
If so, List:
Clearances:
SDP's
Revised 11/1/2015 Page 3 of 3