HomeMy WebLinkAboutCLE201900180 Action Letter 2019-08-12APPROVE)
Application for Zoning.Clearance
CLE # �a U
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE 01�L
Check # (U Date:
Receipt# Staff: (A4 C,
PARCEL INFORMATION
Tax Map and Parcel: 04500-00-00-109C2 Existing Zoning C1 Commercial
Parcel Owner: Access Holdings LLC
Parcel Address: 3315 Berkmar Drive, Suite 2-D City Charlottesville State VA Zip 22901
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? Vivian Rodriguez Archilla, PhD
Address: 3315 Berkmar Drive, Suite 2-D City Charlottesville State VA Zip 22901
Office Phone: (_434) 566-0846 Cell # (787)667-3439 Fax # (434)202-5441 E-mail vmra@cmbhealth.org
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name X New business
Business Name/Type: Center for Mind and Body Health, PLLC
Previous Business on this site Electronic Systems Inc. (ESI)
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:
Psychology private practice; offir-O suite is being used tG by licensed
provide PSYGhotherapy a GI-Aical psychologist.
*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 knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed Vivian M. Rodriguez Archilla, PhD
APPROVAL INFORMATION
pQ 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
Zoning Official Date % / Z p/
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:
Is L
Isn LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y
Wi 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 publi water?
If private well, provide Hea apartment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that app
Is parcel on septic or abbe sewer?
Y
W ou be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y
Wie be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to comnlete the fnllnwina-
Reviewer to complete the following:
Square footage of Use: 12 0
Y N 1 iC�S
Pe,ftnitted as:
Under Section: Z 2. Z .
Supplementary regulations section: N /a
Parking formula: // 2 0 G N S F
Required spaces:
Y� Ite be verified in the field: �� S f'atc!-
a,,a�la 6�
Inspector•
Notes:
Date:
Vio ns:
Y/N
If so, fist:
Prof s:
Y fN
If so -, —Kist:
Al
Variance:
Y /Q
If so, st:
SP's-
Y / *
If so,``�List:
Clearances:
zolti 31
SDP's
19P
-2
c L zo1 Iso
SDIO
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, 4m- L,"t a h 'm 4,- Zt.+w � (tIAA wnCk
[County application name and number]
was provided to Access Holdings, LLC the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number 04500-00-00-109C2
manner identified below:
by delivering a copy of the application in the
Hand delivering a copy of the application to Kerri Bersuder
[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 August 8, 2019
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
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].
-Z4�� 421ew )�,
Signature of Applicant
Vivian M. Rodriguez Archilla, PhD
Print Applicant Name
8/8/2019
Date