HomeMy WebLinkAboutCLE201900054 Action Letter 2019-03-29Application for Zonin Clearance
CLE # 'J 10 Gg5ZZ,-, SGYv
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OFFICE USE ONLY -3 2i /
PLEASE REVIEW ALL 3 SHEETS
Check # CG Date:
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: 046B4-00-00-007C0 Existing ZoningsAa` U ' QU ,.e 1Z —1 S
Parcel Owner:HighLife, LLE C/O Downer Reality
Parcel Address:1800 Timberwood Blvd Suite A City Charlottesville State VA Zip 22911
(include suite or floor)
PRIMARY CONTACT
Who should we calllwrite concerning this project? Matthew Levin
Address :730 Lochridge Lane City Earlysville State VA Zip 22936
Office Phone: (_� Cell # 804-399-4701 Fax# E-mail matt@leyingroup.or
APPLICANT INFORMATION
Check any that apply: Change of. ownership Change of use Change of name X New business
Business Name/Type: WholeHealth Medical, LLC
Previous Business on this site UVA Medical
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:
Family Medicine Medical Practice 4 employees
*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 1 understand them, and that I will abide by them.
Signature Printed Matthew Levin
APPROVAL INFORMATION
Approved as proposed [ ] Approved with conditions [ ] Denied
] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, 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 5 / l
Zoning Official Date 7 f 20
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 Sin
Is LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
Will t 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
Is parcel on private well ox d u lic 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 appl�nbfic
Is parcel on septic or sewer.
Y/N
Will you be putting up a new sign of any kind?
Sign permit.
Permit #
If so, obtain proper
Y / N
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: 735 QO
Wmitted as: Of J tc 14 — r 6Q
Under Section:
Supplementary regulations section:
Parking formula: I ( Zoo
Required spaces:
Y /
Items be verified in the field:
Inspector:
Notes:
Date:
Viol,ons:
If/jT,
If so, ist:
/� J Q�
Proff s:
Y/
If so, st.
Variance:
Y !
If so,�ist:
� j
IVy�
Is•
Y N
so, List:
_ _
SP l b4��5
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,
was provided to
[County application name and number]
[name(s) of the record owners of the parcel]
and Parcel Number
manne dentified below:
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
[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]
tY
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
M L(-- ,/
Print Applicant Name
�
Date/
3/21 /2019
Centralized Payments
(D Your Payment
Was Submitted
Transaction ID: 1OC95289SX850664M
Transaction 03/21/2019 11:57
Time: AM
Total Paid: $55.69
We will receive notification of your online payment at the time that it is made and
we will credit your payment as of that day. However, you will not see the payment
on your account for approximately 48-72 hours due to the time that it takes to get
those funds into our bank account.
Item Amount
Website Payment $54.00
Item Number: 5F2B37
Type: Community Development
Other
Notes: Zoning clearance 1800
Timberwood Blvd Suite A
Transaction Fee $1.69
Total $55.69
https://www.albemarlecountytaxes.org/payments/default.aspx 1/1