HomeMy WebLinkAboutCLE201600053 Application 2016-03-14Application for Zoning Clearance
CLE # DbQ �.3
OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS Check# 661 Date:
Receipt # —69:3 Staff:
PARCEL INFORMATION
Tag Map and Parcel: 061 YO -00 -OA -20400 Existing Zoning NMD
Parcel Owner: MODULAR BUILDING INSTITUTE
Parcel Address: 944 Gienwood Station Lane, Ste 204 City Charlottesville State VA Zip 22901
(include suite or floor)
PRIMARY CONTACT
1,41ho should we call/write concerning this project? Steven Williams
Address :944 Glenwood Station Lane, Ste 204 City Charlottesville State VA Zip 22901
Office Phone: (434) 202-8180 Cell # Fax # E-mail steven@hardimanwilliams.com
APPLICANT INFORMATION
Check any that apply; Change of ownership Change of use Change of name X New business
Business Name/Type: Association Management
Previous Business on this site NIA - Renting an office space from Owner
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:
*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.
a
Signature Printed 7_e V6i "-"1441444f
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 o
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: I Reviewer to complete the following:
Y 1 Square footage of Use:
Is us LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
ennitted as:
Y/
Will tWre be food preparation? Under Section: _74,4
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from Health Supplementary regulations section:
Dept. FAX DATE
Circle the one that applies Parking formula:
Is parcel on private well o u lic r? ��Al
If private well, provide He Ment form.
Zoning review can not begin until we receive approval from Health Required spaces:
Dept. FAX DATE _2r
Y/N
Circle the one that appl' Items to be verified in the field:
Is parcel on septic o public sewer?
YIN
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit # Inspector • Date:
YIN Notes:
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Violations:
Y /(9
If so, List:
offers:
/N
f so, List: x
YI(9Van'ce:
If so, List:
Y
SP'A'i.
If
Clearances:
SDP's
Revised 11/1/2015 Page 3 of 3