HomeMy WebLinkAboutCLE201600180 Application 2016-09-02Application for Zoninz Clearance
CLE #i' liL L 1
OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS Check # 3,3 Date:
Receipt # /US4 Staff: $.
PARCEL INFORMATION
Tax Map and Parcel: 061 WO-01-OA-009AO Existing Zoning C-1 T
Parcel Owner: Sue A. Albrecht
Parcel Address: 2300 Commonwealth Drive City Charlottesville State VA Zip 22901
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? Sue A. Albrecht
Address: 255 Ipswich Place City Charlottesville State VA Zip 22901
r
Office Phone: (434) 531-24 6'� Cell# 434-531-243135Fax# 434-973-0732 E-mail sue@designenvirons.com
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name X New business
.Business Name/Type: The Ellis Group, LTD
Previous Business on this site Rimm Kaufman
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:
-Real Estate Appraisal, 2 Umployess, 1 Shift, 48 Available Parking SpaGes & No Gompapy V@hiclo
*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 wn or lia the wner's pennissio to use the space indicated on this application. I also certify that the information provided
is true and accurat the bes i wled e. I ha v read the conditions of approval, and I understand them, and that 1 will abide by them.
Signature Printed Ilzurp A gX4j47!-_w
A"OVAL INFORMATION
[V Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, x1 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 Date C� -_c.
Zoning Official Date i
h /1re
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/O
Is use in L,I, HI or PDIP zoning? if so, give applicant a Certified
Engineer's Report (CER) packet.
Yl
Pere
Will 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
Reviewer to complete the following:
Square footage of Use:
Y/N
Permitted as:
Under Section:
Supplementary regulations section:
Circle the one that applies Parking formula: `��
Is parcel on private well or p li r? 36b Y i[,l %Y
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health Required spaces: �.
Dept. FAX DATE
Circle the one that applie
Is parcel on septic or p he se
Y/V
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit
YIN
Will ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zonine to complete the followine:
YI
verified in the field:
Inspector:
Notes:
Violations:
Y/N
If so, List:
Proffers:
Y/N
if so, List:
Variance:
YIN
If so, List:
SP's:
Y/N
If so, List:
Clearances:
SDP's
Revised 11/1/2015 Page 3 of
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, Sue A. Albrecht
[County application name and number]
was provided to Sue A. Albrecht
[name(s) of the record owners of the parcel]
and Parcel Number 061 WO-01-OA-009A0
ner 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 Commonwealth Business Center
[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 pplicant
Sue A. Albrecht
Print Applicant Name
Date
EXHIBIT A
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DESIGNED • 8111LT • RIRWSHED • IN27ALCED
SINCE 19T9
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340 GREENBRIER DRIVE CHARLO=SI ILLE, VIHGINIA 22901
DATE: BY: