No preview available
HomeMy WebLinkAboutCLE201900165 Application 2019-08-05J) Application for Zonin Clearance." CLE # OFFICE USE ONLY PLEASE REVIEW ALL 3 SHEETS Check# 050$ Date: 7- 2,6 Receipt # F t $ Sb $ Staff: M, r i PARCEL INFORMATION Tax Map and Parcel: Existing Zonin Parcel Owner: Ballif Investments, LLC Parcel Address: 172 S Pantops Drive, Suite C City Charlottesville State VA Zip 2291 (include suite or floor) PRIMARY CONTACT Who should we call/write concerning this project? Kris SantaMaria Address: 1120 Snowden Drive City Charlottesville State VA Zip 2291 Office Phone: (4 ) 961-2555 Cep # 434-249-1304 Fax # 434-961-2556 Email kris@riverbendcounseling.net APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name X New business Business Name/Type: Riverbend Integrative Trauma Treatment/mental health counseling & training ,,.s�fs Ca IJ,�SL 4 & Previous B iness on this site real estate 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: mental health r^n1tn-gPlina 1 Pm�[Q�PAS�ylllar riavtimP hnurc,Pplploype and) rliPnr Vehicles r *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, I understand them, and that I will abide by them. /and Signature I Printed �t--- A P OVAL INFORMATION [ Approved as proposed [ ]Approved with conditions [ ]Denied [ J Backllow prevention device and/or current test data needed for this site. Contact ACSA, 977--f511, x117. [ J 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 Zoning Official Date ` 5-1 r Other Official Date wunty o[ 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 �, , Zoning Clearance Checklist Applicant MUST HAVE the following information to apply for a Zoning Clearance: 1) Tax Map and Parcel or Address, Building Name, Suite/Unit/Floor numbers, if applicable. 2) A Floor Plan - either a sketch or an architectural drawing a) If using less than the entire structure, note the location within the structure; b) Note the total square footage of the use; c) Note the square footage of each room or area of use; d) Note the use of each room or area of use. FEES Zoning Clearance = $54 Temporary Fundraising Activity = No fee Conditions of Approval FIREWORKS: 1. No person shall sell, offer for sale, store, display or discharge any fireworks in any filling station or on any premises where gasoline or other inflammable liquids are stored or dispensed. (Code 1967 10-13.) County Code Section 6-200 and 6-300 and must be a minimum of 100 ft from any gas pumps/propane distribution tank. 2. The site shall be cleaned and restored to its original condition on or before July 1lth. This shall include removal of all structures, signs, debris, and the like. 3. A thirty (30) foot front setback shall be maintained, Display shall be located so as to avoid traffic congestion. Modifications subject to Zoning Administrator's approval. 4. Building permits shall be obtained for all proposed structures and/or lighting. 5. Sign permits shall be obtained for all proposed signage. 6. The sale of fireworks requires a special permit from Fire/Rescue department. CIMSTMAS TREES: 1. The outside storage of combustible material or flammable materials shall be located so as not to constitute a hazard and shall not be less than 15 feet from any building on the site. Any open burning must comply with the Virginia Statewide Fire Prevention Code and the Albemarle County Code. 2. The site shall be cleaned and restored to its original condition on or before January 2. This shall include the removal of all structures, signs, debris, and the like. 3. A thirty (30) foot front setback shall be maintained, Display shall be located so as to avoid traffic congestion. Modifications subject to Zoning Administrator's approval. 4. Building permits shall be obtained for all proposed structures and/or lighting. 5. Sign permits shall be obtained for all proposed signage. OTHER REVIEWS: 1. Is the property on public or private water/sewer? Private requires Health Department, Public requires ACSA review (2 to 5 days) 2. Will you be operating a bakery? USDA review is required (approx. 2 weeks but as long as 6 weeks) 3. If you are serving prepackaged baked goods but not making them on the Premises, only Health Department will review. (2 to 5 days) 4. If you will be operating any business that is in an industrially zoned district or of an industrial nature you will need to provide a Letter of Performance Standards or Certified Engineer's Report (a staff member will provide an information packet addressing this requirement) (5 to 10 days as soon as the Letter or Report is received by this Department) 5. If there has been no site inspection within the last three (3) months for the parcel/site, then one will be conducted to verify that the project is in compliance with an approved site plan (if applicable). Revised 11/l/2015 Page 1 of 3 Intake to complete the following: YV IsLI,HI or PDIP zoning? Engineer's Report (CER) packet. Y 'DJ 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 o ublic wat If private well, provide Health epartment 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 / O Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Y Wi �re 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: 1t J rmitted as: Under Section: Supplementary regulations section: _ Parking formula: X uePegu� � oti-5t�r' Required spaces: 1 Z Ct L/q � lq bCe Y/N Items to be verified in the field: Inspector: Notes: Viol Y I(NI If so, 'st: .----- Proffers: Y / If so, st: Varian Y(NI If so;List: — SP's: Y/ If so'�st: Clearances: 2 O r G` 3?, 2 Ol 1 -? a SDP's 2VZ'-I" I �, '2©ly-lob 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 (4 L�T1 [ �� [County application name and number] was provided to 0 % 5 o 0 ._ Cc U o 5 C Ci the owner of record of Tax Map [name(s) of the record owners of the parcel] and Parcel Number OA_t (rE LLL- 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 E6 Mailing a copy of the application to *E/J-,�A (/NJ��' 7 [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 —( Z3 cl to the following address: Date I [address; written notice mailed to the owner at de 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] . �Ao<ijj Signature o App _cant Print Applicant Name Date Exhibit A SUPPLEMENT TO LEASE DA,riu): BETWEEN: l2iverbend Counseling Group, LLC. (Tenant) AN7) Ballif Investments, LLC (Landlord) AND Management Services Corpuratiou of Charlottesville (Agent) FLOOR PLAN SHOWING THE LEASED PREMISES 171 T'ANTOPS S�:CONO FLOOR PLAN 16 henant's Initials