HomeMy WebLinkAboutCLE202100048 Application 2021-04-08 (2)K gF
J2� d Albemarle County
Zoning Clearance Application Communitle Rd, None
4gt Molten e, N229 Wing
Chatloaesvllle, VA 22902
c �8p Phone 434.296.5M2
FOR OFFICE USE ONLY Clearance Number: L' `ral — APPROVED
Fee Amount: $ 54
Receipt #:0 -1l niM514%1 V
ey. by the Aibemafle County
Community Development Department
By: ilata _
I
Applicant - Fill out the entire page below
And return to Community Development 401 McIntire Rd, North Wing, Charlottesville, VA 22902
Date Paid: 3I ') I
Check #: C .C,
Name:
John Thier
E-Mail Address:
john@turner-enterprises.com
Mailing Address:
PO Box 521, Charlottesville, VA 22902
Phone #:
Tax Map and Parcel
number and/or Address
of the Business:
330 Claremont Lane, Crozet, VA 22932
Zoning:
Staff will fill out'If unknown
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Parcel Owner:
Old/rail Medical Arts LLC
Owner's Address:
Box aro esvl e,
Check any that apply:
New Business ❑ Change of Use ❑ Change of Ownership ❑ Change of Name
Business Name:
!Crozet Pediatric'Dent
Description of Business:
Describe the business including use, number of employees, number of shifts, availability of parking, and any additional info.
A patient -centered pediatric dental practice that works with children from infancy through young adulthood and with special
needs patients of all ages 6 employees, 1 shift
Previous Business on Site:
N/A
Floor Plan:
Please attach either an architectural drawing or a sketch of the proposed business indicating the location of uses, the
uses of rooms, the total square footage of the use, and any additional information.
Total Square Footage Used
for the Business:
3,478 Net SF
Is the Parcel Zoned LI, HI, or PDIP?
Yes No If yes, fill out a Certified Engineer's Report (CER)
Will there be food preparation?
Yes No If yes, provide Virginia Department of Health approval
Is the Parcel on public water or private well?
Public Private If on private well, provide Virginia Department of Health approval
Is the Parcel on public sewer or septic?
Public Septic If on septic, provide Virginia Department of Health approval
Will you be putting up any new signage?
Yes No If yes, obtain appropriate sign permit and list permit # below
Will there be new construction or renovations?
Nyes No If es, obtain appropriate buildin yg permit and list permit #below
Please list any applicable Building Permit #s:
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Zoning Clearance review cannot begin until the application above is complete and all applicable forms and fees are submitted.
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 abide by them.
/
Signature f"--' Printed John Thier
Date 3/24121
2
2� Albemarle County
Zoning Clearance Application 4 � ° G°mm°°fiy0eveNorthW . 401 MclNire Rd. North Wing
-�"• Chadotlesvillo, VP 22902
M{8GIN1� Phone 434.296.5632
Applicant - If you are not the land owner, please fill out the entire page below confirming that you have either
informed or are going to inform the owner of your zoning clearance application.
CERTIFICATION THAT NOTICE OF THE APPLICATION HAS BEEN
PROVIDED TO THE LANDOWNER
I certify that I will provide (or have provided) notice of this clearance application,
clearance number provided by Staff or business name
to the owner
Name of landowner on record
of Tax Map and Parcel Number by either delivering a
TMP number of property
copy of the application to them in person or by sending them a copy of the application by
mail. (Please check one of the following below)
❑ Hand delivering a copy of the application to the owner identified above on
Date
❑ Mailing a copy of the application to the owner identified above on
Date to the following address:
(Written notice to the owner and last known address on our record books will satisfy this
requirement. Please see staff for help determining this information if needed)
Signature of Applicant
Applicant Name Printed
Date
R]
For Albemarle County Staff Review Only
Proposed Use:t
0(eiz
Permitted:
Yes ❑ No
Permitted by Section:
Otv C+0r Pr
Supplementary Regulations:
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Applicable Special Use Permit (SP):
Applicable Rezonings (ZMA):
2-0
Applicable Site Plans (SDP):
ZO2-0-
Parking:
If there is an approved site plan associated with the parcel, the parking requirements will be defined by the SDP. Some
parking requirements are determined by a ZMA or by an 9pproved Code of Development.
Parking Formula:
y ZBg yL
Defined by:
I lqsljte Plan ❑ Zoning Ordinance ❑ COD ❑Existing
Total Square Footage of the Use:
3 4179
Required number of parking spaces:
/ Srt�� 7 1 ��� ✓ 5-✓1iOZd ZQ—�5
Yr
Associated Clearances:
'� OX i _ Y7 _
Variances:
�-
Violations:
Z-Ujo 2 OC/,S'49
Is a site inspection necessary?:
Yes ❑ No
Site Inspection on (date):
To Confirm:
Notes:
4cQd'iC l/ ,e S Q42Dv2 OLGyl�JI2f 574ure
Conditions of Approval:
Additional conditions of approval apply to Fireworks and Christmas Trees
Appr9val Information
❑ Approved with conditions
Approved as p7device
❑ Denied
❑ Backflow prevand/or current test data needed for this site. Contact ACSA, 434.977.4511 ext. 117
❑No physical sihas been done for this clearance.
Therefore, it is not a determination of compliance
with the existi❑
This site compite plan as of this date.
Conditions:
Additional Notes:
Building Official
—Date�4y /�
Zoning Official
Date ! C Z�
Other Official
Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Phone: 434.296.5832 Fax: 434.972.4126 4
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