HomeMy WebLinkAboutCLE201900266 Application 2019-11-21Application for Zoning Clearance - c-c i
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE O Y I
Check # �� 3 Date:
Receipt 41 Staff, 1tiA [�
PARCEL INFORMATION
Tax Map and Parcel:-@9 Existing Zoning Planned Dvlp Mixed Comm
Parcel Owner: Demrep, LLC c/o Jane Ray
Parcel Address: 690 Berkmar Circle City Charlottesville State VA Zip 22901
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? Katie Caverly
Address : 690 Berkmar Circle, Suite 311 City Charlottesville State VA Zip 22901
Office Phone: 4( 34) 202-8887 Cell # 925-202-9365 Fax # 888-978-7813 E-mail katie.caverly@ikorcharlottesville.c,
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name X New business
Business Name/Type: jKOR of Charlottesville & IKOR Transport, LLC - Senior Care Mgmt and Transport Companies
Previous Business on this site Therapist
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:
IKOR coordinates and manages services for seniors. We have 9 employees but the majority are field based. Only my Admin and I
regularly work in the building. The office use is administrative - we don't produce hard goods, rather, we are a consulting firm.
*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 Ave the 07 er's permission to use the space indicated on this application. I also certify that the information provided
is true and accurate t est of m k wledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature /&/Printed Kathryn Caverly
APPROVAL INFORNkTION
[ ] 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
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:
Y
Is rsl LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
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 applie
s
Is parcel on private we?
If private well, provide form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that a�pplies
Is parcel on septic is
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y /
Wil ere be any new construction or renovations?
If so, obtain the proper Permit. if
Permit # oG ll'1 sy�G� l-V 15
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use:
Y/N /��
rml`-I itted as: Gi,(M I h I P"(15 i t`t /�C
Under Section: 25Ac 2-d '--> z3 t Z, ( C f )
Supplementary regulations section:
Parking formula: 1/2-fie `L` -t
Required spaces: 13 i q(�S-
Y/
ltenktdbe verified in the field: l'
Inspector•
Notes:
Viol ns:
Y/Y�
If so, ist:
Prof
y/Nm
If �(�,�ist:
Vari e:
Y/
If ist:
SP's-
Y/N!)
If s �_
Clearances:
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SDP's
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, IKOR of Charlottesville
[County application name and number]
was provided to Demrep, LLC c/o Jane Ray the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number 61-3A & 3D
manner identified below:
by delivering a copy of the application in the
Hand delivering a copy of the application to Jane Ray
[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 11 /6/2019
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].
- -�7 lze
Signature of plicant
Kathrvn Caverly
Print Applicant Name
11 /6/2019
Date
EXHIBIT A -
FLOOR PLAN
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