HomeMy WebLinkAboutCLE201800142 Application 2018-08-15APPROVED
Applicatio ,;4 WJ71rIQ�uu"` 00,earanceCLE #� ii a.
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OFFICE USE ONLY PLEASE REVIEW ALL 3 SHEETS Check # fC Date:;9/
Receipt# Staff:
PARCEL INFORMATION
Tax Map and Parcel: 061 WO-01-OA-0009BO Existing ZoningC-1 Commercial
Parcel Owner: PMJB Land Trust
Parcel Address:2340 Commonwealth Dr., Suite 207 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: ROFORI CORPORATION
Previous Business on this site Parker, McElwain & Jacobs
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:
Cyber Technology, 1 employee, 1 shift, no company vehicles
*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. 1 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 Printed Sue A. Albrecht
APPAMAL INFORMATION
J,rApproved as proposed [ ] Approved with conditions [ ] Denied
Bac,JrrFlow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, x117.
[ o 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 olw/ I 1_�
Zoning Official Date
Other Official Date
Vu ty vi rA,ucivarit ueparunen[ oI l.ommumty 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: Reviewer to complete the following:
y N Square footage of Use:
1�1
Is us n LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet. �E / N
ermitted as:
Y /
Will ere be food preparation? Under Section: �l
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from Health Supplementary regulations section:
Dept. FAX DATE
Circle the one that applies
Is parcel on private well or public 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 applies
Is parcel on septic or public sewer?
Y�Will/ou be putting up a new sign of any kind? If so, obtain proper
Sign permit.►
Permit #
Y
Will re be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zonin2 to complete the followin :
Parking formula: . 1
Required spaces:
Y/N
Items to be verified in the field:
Violations:
Y/N
If so, List:
Proffers:
Y/N
If so, List:
Variance:
Y/N
If so, List:
SP's:
Y/N
If so, List:
Clearances:
SDP's
Revised 11/1/2015 Page 3 of 3