HomeMy WebLinkAboutCLE201800018 Application 2018-01-23Application for Zoning Clearance_``
PLEASE REVIEW ALL 3 SHEETS
OFFICE US + ON A
Check # 5 Date:
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: 061 YO-00-OA-1 0200 / 061 YO-00-OA-1 0300 Existing Zoning
Parcel Owner: Commercial Rentals
Parcel Address: 944 Glenwood Station Lane, Unit 102-City Charlottesville State VA Zip 22901
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? Helen Cauthen
Address : 2211 Hydraulic Road, Suite 104 City Charlottesville State VA Zip 22901
Office Phone: ( 434) 979-5610 Cell # 434-218-9477 Fax # 434-979-4123 E-mail hcauthen@centralvirginia.org
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name X New business
Business Name/Type: Piedmont Workforce Network - One -Stop Workforce Center
Previous Business on this site N/A - renting office space from the 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:
Ope-Stop Workforce TypiGal office
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*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 alta� Printed Helen Cauthen
A)ROVAL INFORMATION
[" Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] ckflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, xl 17.
[Clf 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 Officia Date
.. ll
Zoning Official V Date �= t
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/0
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y /
Will 2ere 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 o Cpubliie water
If private well, provide Heapartment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that appli
Is parcel on septic oelic sewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit. ���`
Permit # To be 0,*oled
Y / N ����d iNtLvti t SZFr �� froill
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:
Square footage of Use:
q-L I -7
ermitted as: t if essi G A Gi
Under Section: ZNIN Lti:C COP
Supplementary regulations section:
Parking formula:
l 1 J
Required spaces: f 7
Y N
ite o be verified in the field:
Inspector :
Notes:
Date:
Violns:
Y.(NJ
Ifs ist:
Proffers:
Y/N
If so, List:
zMw zc•E' 13
Var' ce:
Y/M
If so, ist:
SP'
Y/N
I ist:
Clearances:
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 Commercial Rentals LLC
[name(s) of the record owners of the parcel]
the owner of record of Tax Map
and Parcel Number 061 YO-00-OA-10200 / 06YO-00-OA-1030(by delivering a copy of the application in the
manner identified below:
0 Hand delivering a copy of the application to Devyani Gharadia,Owner,1024 Carrington PI, #100
[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 1/22/18
Date
0 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 Applicant
Helen Cauthen
Print Applicant Name
1 /22/18
Date
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