HomeMy WebLinkAboutCLE201900281 Application 2019-12-09APPROVED
by the Albemarle County
Community Development Department
Application for Zonin Clearanc
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check# :7073,5� Date: lZ'7�j�
Receipt # Gip I Staff: 'VlC_,
PARCEL INFORMATION
Tax Map and Parcel: 07800-00-00-,0B1-9_ (G b Existing Zoning PD-MC
Parcel Owner: PJP PropCo I, LLC
Parcel Address: 675 Peter Jefferson Pkwy, Suite 300 City Charlottesville State Virginia Zip 22911
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? Greg C. Nelsen
Address : 675 Peter Jefferson Pkwy, Suite 300 City Charlottesville State Virginia Zip 22911
Office Phone: ( 434) 817-6913 Cell # 434-906-4169 Fax # 434-245-0251 E-mail greg.nelsen@hopva.org
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: Hospice of the Piedmont/hospice services
Previous Business on this site Hospice of the Piedmont
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:
*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 bes my knowl ge. I have read the conditions of approval, and I understand them, and that I will abide by them.
f
Signature C' Printed Greg C. Nelsen
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 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— ---(C
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/NO
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y/ND
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 public water?
If private well, provide Healt 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 o ublie sewer?
------------
Y /'0
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
j)/ N
Will there be any new construction o renovations?
If so, obtainAhe proper Permit.
Permit# K
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Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: 15 , (v 3
N r,Amitted as: ON (�
Under Section: v'S t
Parking formula:
Required spaces:
( 6 V
/--\ -
Y/N
Item o be verified in the field:
Inspector
to
Notes:
Violations:
Y/N
If so, List:
Proffers:
Y/N
If so, List:
Variance:
Y/N
If so, List:
SP's:
Y/N
If so, List:
Clearances:
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, Zoning Clearance
[County application name and number]
was provided to PJP PropCo I, LLC the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number 07800-00-00-0310 by delivering a copy of the application in the
manner identified below:
Q 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
Mailing a copy of the application to PJP PropCo I, LLC, c/o Jamie Varon, Senior Property Mgr.
[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 /22/2019 to the following address:
Date
, 8001 Franklin Farms Road, Suite 201 1 Richmond, VA 23229
[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
Greg C. Nelsen
Print Applicant Name
11 /22/2019
Date
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