HomeMy WebLinkAboutCLE201800167 Approval - County 2018-07-13Application for Zoning Clearance
CLE #
°
OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: 061 WO-0 1 -OA-0009BO Existing ZoningC-1 Commercial
Parcel Owner: PMJB Land Trust
Parcel Address:2340 Commonwealth Dr., Suite 200 City Charlottesville State VA Zip 22901
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? Sue A. Albrecht
Address :80 Roslyn Forest Lane City Charlottesville State VA Zip 22901
Office Phone: 4( 34 ) 973-6161 Cell # 434-531-2435 Fax # 424-973-0732 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: Democracy Live Inc.
Previous Business on this site /�
�� f K� ( ' c-
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:
Offering interactive, 21st century voting tools to eligible voters in the U.S. �•��
*This Clearance will oily be valid on the parcel for which it is approved. If you change, intensify or move the use to anew location, anew 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 y dge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Pnn e . Albrecht
ROVAL INFORMATION
Approved as proposed [ ] Approved with conditions [ ] Denied
[ Backflow prevention device and/or current test data needed for this site. Contact ACSA, 9774511, 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 Date
«� o
Zoning Official � ` -S- Date / � � � � e!
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 9724126
Revised 11/02/2015 Page 2 of 3
Intake to complete the following:
Is /(N)
Is uslalin LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
Y/0l
If so, give applicant a Certified
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 uEpairticut
If private well, provide Heal form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies ----
Is parcel on septic or . ublic sewer
Y / N Pejlyy )
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y kl'
���,l,
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:
Y / N Q� f "�--
Permittedas: r►''`� ' f�
Under Section: ZZ •'Z
Supplementary regulations section:
Parking formula: ! n a VOC C
ZoO
Required spaces:
Y/N
Items to be verified in the field:
Inspector Date:
Notes:
ViolM�ons:
Y/�NJ
If so, ist:
Profkrs:
Y/N)
If so —,List:
Variance:
Y
If so, ist:
SP's:
Y/�N
If so, ist:
Clearances: Lit-2 0 f L90
SDP's l zy d Ow P7
Revised 11/1/2015 Page 3 of 3
0
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, Zoni
was provided to PMJB Land Trust
Clearance
[County application name and number]
[name(s) of the record owners of the parcel]
and Parcel Number 061 W-01-OA-009B0
manner identified below:
the owner of record of Tax Map
by delivering a copy of the application in the
IF Hand delivering a copy of the application to PMJB Land Trust
[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 7/3/2018
Date
Q 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].
uG - -Ul Gl l IL
Print Applicant Name
7/3/18
Date
�o
CREST.
MIN
Community Development Department
County 401 McIntire Road Charlottesville,'YC422902-4596
lll'� Voice (434) 296-5832 Fax (434.) 972-4126
C'Unty Of Albemarle
Dlpalment of C.Mrri
-'Ornm Uni"
W-'(' 9 .
pl; Un,'Y Development
PI -I: (434) 296-5832
4629
RECEIVED
UVED F, J'
- Ajw�,- &— �-, 4a, _l - J,/,Pl - .1 .A ,
F 307 V
L it I-,, �
For: 4191—t:7y,
Comments
Legal Ad F-
jSUB APPLICATI
Sub
324
510
check
cash
credi c
By
�)�PPLICANT CONTACT INFORMATION
'- i--2=0—nta4;t—TXFe Narne Address
PMJB LAND TRUST
80 ROSLYN FOREST LANE CHARLOTTESi,ILL 22901
SUE. ALBRECHT 80 ROSLYN FOREST LANE CH44RILOTTESVILL 22901 4349736161 ,434531243
0
Signature of Contractor or.Authorized.Agent Date