HomeMy WebLinkAboutCLE201900195 Action Letter 2019-10-1008/13/ . 2019 TUE S.- 53 FAX U002/005
Appflication for Zqnin�Clearance
cL.g # �,41
OFFICE USONLY
PLEASE RI EVI EW A LL 3 SH VETS Check 9 E 2 Date.,
Receipt # Staff: JkA,
PARCEL INFORMATION
Tax Map and Parcel: 07800-00-00-015F0 Existing Zoning HIGHWAY COMMERCIAL
9E HIGHWAY " V _VIA T U
Parcel Owner: PANTOPS/1 8 3 LLC
Parcel Address: 183 Spotnap Road, Suite B __ City Charlottesville -State VA 7ip 22911
(include suite or floor)
PRIMARY CONI'AC11'
Who should we call/write concerning this project? Michelle Allen
Address: 10800 Midlothian Turnpike Suite 303 City N Chesterfield State VA 7Ap 23235
Office Phone:(§04) 288-0235 Cell# 804-332-1394 tax # 804A82-2911 E-mail michelle.allen@ heartland hospic(
APPLICANT INFORMATION
Check any that apply:_ Change of ownership _Change ofuse Change of name X New business
Business Name/Type; Heartland Hospice
Previous Business on this site SOUTHERN TRUST MORTGAGE
Describe the proposed business including use, number of employees, number of mbifts, available parking spaces, number of
vehicles, and any additional information that you can provide:
Hgspir.@ offir.@-kwatkw44"Fnploy99e; tq stsrt, open Mon -Fri 0-5prn, 10 vohlc�wghly
4"I'his Clearance Nvill only be valid on the parcel for which it is approveLL I f"you change, intensity or move the use to rL new location, a new Zoning
Clwaner, will he requirtxl.
I hereby certify that I own or have tho ownei'H penniWon it) 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 YuHd the cunditionm ol'approval, and I understand them, and that f will abide by them.
Signature ft� - Printcd Michelle Allen RN
APPROVAL INFORMATION
>(Approved as proposed Approved with conditions Denied
[ J Backflow prevention device mid/or current test data needed for this situ. Contact ACSA, 977-4,511, x 117,
�xfNu physical site inspection has been done for this clearance. Thcrufuru, it is not a deterininatinn of compliHnw with the existing
situ plan.
[ ] This site complies with the site plan as of this date"
Notes.
BUINJing Date
Zoning 01171cial Date 0 02
Other Official Date
County of AlbeAuarle 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
08/13/2019 TUE S.' 53 FAX
Intake to complete the following:
el"N"'
/' LR
Ts ILL HT orPDIP zoning? if so, give applicant aCeitified
Engineer's Report (CER) packet.
Y
WiLere be food preparation?
If so, give applicant a Health Department form.
Toning review can not begin until we roccivu approval from health
Dept, FAX DATE
Circle the ne that applies
Is parcel on private well or �;,blic water,7)
If private well, provide Healtli"Mij-dfffil"t form.
7oning review can not begin until we receive approval from Ileakit
Dept, FAX DATE
Circle the one that appiijw-
is parcel on septic or ubhc Sewer?
Y / N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit,
Permit #
Y / N
Will there be any now construction or renovations?
If so, obtain the proper Permit.
Permit #
Mete the following:
Varl7ce:
V
if so,
Reviewer to complete the following:
e -7 '5
Square footage of Use: I
Y 1) N
Parinittcd as;
I hider Suction; '2. 4, 2 , (
Supplernentary regulations section: P'// 'A
Parking formula'. Z 00
Required spaces:
6,
Y /(N
ltemro be verified in the field;
Inspector:
Notes.
Prof s:
Y . 'rN
fisC V0
'S P
Y
If s Otist;
Clearances; L' () (� ( j (a SDP's
�56
Date:
Revised 11/1/201.1 Page 3 of 3
08/13/2019 TUE 8.-53 FAX
I
•
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
ThLvform must accompany zoning applications (Home Occupation, Zoning Clearance, Zoning
Administrator Determinations or Appeals, Sign Permits, Building Permits) fj"the application IV not the
owner.
I certify that notice of the application, Zoning Clearance
[(,'ounty application name and number]
was provided to PANTOPS/183 LLC
[name(s) of the record owners of the parcel]
and'Parccl Number 07800-00-00-015F0
manner identified below:
the owner of record of Tax Map
by delivering a copy of the application in the
I land 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
I )ate
aD Mailing a copy of the application to Piantops/1 83 LLC
[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 8/9119
Date
to the .following address:
PO BOX 7814.7 Charlottesville, VA 22906
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 I,
ftmature of Applicant
Michelle Allen RN
Print Applicant Name
8/9/19 —
Date
08/13/2019 TUE 8:54 FAX
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