HomeMy WebLinkAboutCLE201900204 Application 2019-08-29APPROVE
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Application for Zoning Cie ran
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CLE #
OFFICE US
Check # Date:
PLEASE REVIEW ALL 3 SHEETS
Receipt # Staff:
PARCEL INFORMATION
06100-00-00-024BO
Tax Map and Parcel: Existing Zoning
Parcel Owner:CLMB LLC (Charles Swisher and Mark Sapon (Members of LLC))
Parcel Address:80 Whitewood Road City Charlottesville State Virginia Zip 22901
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? Charles Swisher
Address :259 Hydraulic Ridge Road Suite 203 City Charlottesville State Virginia Zip 22901
Office Phone: 4( 34 ) 9731222 Cell # 4345669868 Fax # 4349732255 E-mail brad@swisherdentistry.com
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use X Change of name X New business
Business Name/Type: CLMB LLC will rent to Sapon and Swisher Dental PLLC / Dental/Medical Office
Previous Business on this siteNude Fude
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:
Professional Dental Office, 18 employees, 8am-5pm m-f shifts, 32 parking spots. Patients are usually seen on the hour
for one hour appointments.
*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 I understand them, and that I will abide by them.
Signature PrintedCharles B. Swisher
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 ysical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
site p n.
[ L.,Vrhis site complies with the site plan as of this Oate.
Notes: `j%�JD ZD 1 7 —
Building Official Date
Zoning Official Date
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
,>a0(� - 1-081
Intake to complete the following:
Is /
Is u m LI, HI 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 ublic water
If private well, provide Health ein
—ppa7 merit form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that appl'
Is parcel on septic public sewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
/N
ill there be any new construction or renovations?
If so, obtain the proper Permit.
Permit # 62_p(G7—2Z9L(
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: 5-06 5
I'Llrmi ted as: Of f, c,e
Under Section: 2 Z • Z ,
Supplementary regulations section:
N/Iq
Parking formul i. / ' 5
Required spaces: 2 9 2 3
Item o be verified in the field:
Inspector Date:
Notes:
Violations:
Y/�
ITS st: ��� e
Prof
Y/
If so, List:
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Vari
If so, List, n /
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Revised l l/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
manner identified below:
Q 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]
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].
Signature of Applicant
Print Applicant Name
Date