HomeMy WebLinkAboutCLE201600102 Application 2016-06-08Application for Zonin Clearance
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CLE #
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OFFICE USE LY
PLEASE REVIEW ALL 3 SHEETS
Check # JAIrla Date: Ll a 10
Receipt # Staff:
PARCEL INFORMATION ,
Tax Map and Parcel: 045CO-03-000BO Existing Zoning
Parcel Owner: Todd Needham
Parcel Address: 920 Gardens Blvd Ste 100 City Charlottesville State VA Zip 22901
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? Michael Orsini
Address: 999 W Big Beaver Rd City Troy State MI Zip 48084
Office Phone: (248) 244-4277 Cell # Fax # 248-244-5343 E-mail corptaxusa@kellyservices.com
APPLICANT INFORMATION KELLY SERVICES USA, LLC
Check any that apply: Change of ownership Change of use Change of name X New business
Business Name/Type: temporary help service
Previous Business on this site
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:
178 c�_1Shift
*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 th best f m, owledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed Michael F Orsini VP, Tax & Treasurer
APP VAL 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 A J 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 11/02/2015 Page 2 of 3
Intake to complete the following:
Is / Is u u1Oth LI, H[ or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
ee
Y / �..
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 lic Ovate
If private well, provide Health artment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that appl'
Is parcel on septic or Jablic sewer?
YIN
Will 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:
footage of Use:
1 f/ N
ermitted as:
Under Section:���
Supplementary regulations section:
Parking formula:
Required spaces:
YIN
ltertAe verified in the field: /
Inspector:
Notes:
Date:
Violations:
YIN
If so, List:
Proffers:
Y/N
If so, List:
Variance:
Y/N
If so, List:
SP's:
Y/N
If so, List:
Clearances: n s �
SDP's
Revised 11/1/2015 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 Todd Needham
[name(s) of the record owners of the parcel]
and Parcel Number 045CO-03-00-OOOB0
manner identified below:
Q Hand delivering a copy of the application to
the owner of record of Tax Map
by delivering a copy of the application in the
[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
0 Mailing a copy of the application to Todd Needham
[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:
788 Jefferson Dr. Palmyra, VA 22963
[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
Michael F. Orsini
Print Applicant Name
q
Date