HomeMy WebLinkAboutCLE201700284 Application 2017-12-29Application for Zoning Clearance
CLE #
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # Date:d ( -7
Receipt # Staff: , a —
PARCEL INFORMATION
Tax Map and Parcel: _ _ G I U - 03"lA Existing Zoning Highway Commercial
Parcel Owner: Berkmar LLC
30-;�ig5
Parcel Address: Berkmar Drive, Suite A City Charlottesville State Virginia Zip 22901
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? C Michael Dalton
Address : 6335 Ivey Hill Drive City Cumming State Georgia Zip 30040
- P
Office Phone: 4( 34) 336-7717 Cell # 678-596-4368 Fax # E-mail cmdalton@notarymotion.com
APPLICANT INFORMATION X RELOCATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: NotaryMotioN, LLC
Previous Business on this site Jennifer Kupiec, CMT (recently sold to W Jeffrey Dalton, CPA)
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:
Bookkeeping, Workflow and Data Analytic Services - Single Member LLC - rented space no additional employees
no shifts, existinq customer parking
*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.
Signature �'�_ nted C Michael Dalton
APPROVAL INFORMATION
[vf Approved as proposed [ ] Approved with conditions [ ] Denied
[ ]�,,Bckflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, x117.
[lo 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
-�
Other Official Date
%_ounry of Atoemarie liepartment 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 Oin LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /1'iRet' Wily e 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. ublic water.
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that apkes
Is parcel on septi or public sewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit# VJNld govvliQ1
(Pevc,�d'�C"M-O
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit # LL 1
WVAJ A ve,b lv�, G1 S��c:�^t1e pRlp^'I
Zoning to complete the following:
Reviewer to complete the following:
i Square footage of Use: 15 h
Wrmittedas: Ofi to,
Under Section:
Supplementary regulations section
Parking formula: I
Required spaces: 16
Y N
Ite o be verified in the field:
Inspector : Date:
Notes:
Vi s:
Y N
If so, ist:
Pro
y
Ifs ist:
Va
Y/N
If t:
SP,
Y/Pi.
If
Clearances: 1�
CU, 'LON `I-L� 3Qt,r,►far RUe
SDP's
lot
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, Application for Zoning Clearance (Albemarle County)
[County application name and number]
was provided to Berkmar LLC
[name(s) of the record owners of the parcel]
the owner of record of Tax Map
and Parcel Number Tax Map 061 / Parcel 120_ by delivering a copy of the application in the
manner identified below:
0 Hand delivering a copy of the application to W Jeffrey Dalton, CPA - member
[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 12/10/2017
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 Applican
C Michael Dalton
Print Applicant Name
12/ 13/2017
Date
0
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