HomeMy WebLinkAboutCLE201600258 Application 2016-11-21Application for Zoning Clearance_°F.Y
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check# L03 Date: III t0
Receipt # —7 J Staff:
PARCEL INFORMATION
Tax Map and Parcel: 059D2-01-00-01800 Existing Zoning
Parcel Owner: UVA Foundation
Parcel Address: 1 Boars Head Pointe, Ste 121 City Charlottesville State VA Zip 22903
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? John N. Couric
Address :6923 Williams Run Rd City Port Republic State VA Zip 24471
Office Phone: 4( 34) 282-0025 Cell # 540-560-3354 Fax # 888-392-2646 E-mail lohncouric@gmail.com
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name x New business
Business Name/Type: Providence Asset Management, LLC
Previous Business on this site Profile AI
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: Financial Services business.
One principal only - John N. Couric - no other employees. 9:00 AM - 5:00 PM Ample parking at Boars Head Pointe
*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 permissign 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.1 h e read the conditions of approval, and I understand them, and that I will abide by them.
Printed
Signature N John N. Couric
APPROVAL INFORMATION
W Approved as proposed [ ] Approved with conditions [ ]Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, 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 Date ((�
Zoning Official Date %-, � �-=d2
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
Intake to complete the following:
Y
Is use m LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Will
Will 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 Parking formula:
Is parcel on private well or yvater? 2y O
If private well, provide alth artment form.
Zoning review can not begin until we receive approval from Health Required spaces:
Dept. FAX DATE
Circle the one that apptis
Is parcel on septic or public se ?
Y/N
Will you be putting up a new sign of any kind?
Sign permit.
Permit #
Reviewer to complete the following:
Square footage of Use: 1 Z J
N
Permitted as: 1 C.G
Under Section: 2 �/ . 2- .1
Supplementary regulations section:
Y/
Items to be verified in the field:
If so, obtain proper
Inspector : Date:
Y / N Notes:
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Violations:
Y /6)
If so, List:
Proffe :
Y /
If so, ist:
Variance:
Y/
If so, ist:
SP's:
Y/6)
If so, ist:
Clearances:
SDP's
Revised i 1/l/2015 Page 3 of 3
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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 UVA Real Estate Foundation
[name(s) of the record owners of the parcel]
and Parcel Number 059D2-01-00-01800
manner identified below:
0 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
] Mailing a copy of the application to UVA Foundation
[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 11 /14/2016
Date
to the following address:
UVA Foundation - attn: Mary Jane Bredder - 1 Boars Head Pointe, Charlottesville, VA 22903
[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].
4
Signature of Applicant
John N. Couric
Print Applicant Name
11 /14/2016
Date