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Home My WebLink AboutCLE201900068 Application 2019-04-16APPROVEl by the Albemarle County Cornmunit,; --fit f)epartmont Date t i f,., c - Application fi01L n' Clearance CLE # REVIEW USEY PLEASE REVIEALL 3 SHEETS ChDate: eck # Receipt # I Staff: PARCEL INFORMATION Tax Map and Parcel: -)I I LJ 0— 01 — Q — Oo3 /+0 Existing Zoning Cim yti, Parcel Owner: lk �" Lt rh„a 1—Pn��N�(S�t n Parcel Address; 2321 Commonwalth Drive Charlottesville VA 22901 -- CityState Zip (include suite or floor) PRIMARY CONTACT Phillip C. Love Who should we callhvrite concerning this project? Address : 1001 E. Market Street, Suite 200 City Charlottesville State VA Zip 22902 Office Phone: (434) =Z-- Cell #-50-499-722Vax # E-mail APPLICANT INFORMATION plove@wholewomanshealth.cq Check any that apply: Change of ownership Change of use Change of name New business Business Name/Type: Medical Clinic (Gynecology/Abortion Services) Previous Business on this site 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: _Medic&I—runic/--E—mployee- *This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move the Clearance will be required. use to a new location, a new Zoning I hereby certify that % have the ow er's permission to use the space indicated on this application. I also certify that the inlormation provided is true and accura to I my o% ed . Ihave re ie conditions of approval, and I understand them, and that I will abide by them. Signature Printed Phillip C. Love APPROVAL INFORMATION -- [ ] Approved as proposed [ ] Approved with conditions [ ) Denied ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-451 1, x 117. ]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 G� Zoning Official ' Date c`— 1 G' 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 1 1,1/2015 Page 2 of 3 Intake to complete the following: Y IsLk_eiwtI, IJI or PDIP zoning? Engineer's Report (CER) packet. If so, give applicant a Certified Y; Wil 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 or blic w If private well, provide Healt inent form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE __ Circle the one that appli Is parcel on septic o ublic�verr Y / N Will you be putting up anew sign of any kind? If so, obtain proper Sign permit. Permit # Y / N Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # Zoning to complete the followin Reviewer to complete the following: Square footage of Use: Z/ C J ? Of "( VY N ,,,,�� ermitted as: �(�'l. off, g Under Section: 2 3,z = ( C z Supplementary regulations section: Parking formula: � z-O.;n9 Required spaces: it Y/N Items to be verified in the field: ` Inspector: Date: Notes: y'f Viol s: Proffevs: YIN YIN If so, ist: If s ist: Varia e: Y SP's: Y If so, ist: If s&t: Clearances: SDP's I Revised 1 I/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, Albermarle C L, ( Z r✓' ( el - 6 S [County application name and number] was provided tov Shy e the owner of record of Tax Map [name(s) of the record owners of the parcel] and Parcel Number Q(Q\ 00- 0� -0-4 -- (')Q-31�Q by delivering a copy of the application in the manner identified below: Hand delivering 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 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 fwcxve� Z:�-, Z-09 to the following address: Date [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]. ignature o4A41i nt -?�, 11`L 1-2 C, Lo �l-e Print Applicant Name ,3>i0%7-1 1 � Date C.) N 1.00W gee; ALS* io t,7 -j _5. C\1 V-) P f �� 611 now cefing fanVo combo 3' flex duct vented tru side Mechanical plans 2321 Commonwealth Dr.