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HomeMy WebLinkAboutCLE202100164 Application 2021-12-06Zoning Clearance Application P Mnit rte County Col Mdrh Rd, 401 Mdmire0. N4M Wog Ctla0otl4sWlls. VA 23902 Poona 434.296.5832 I f n Applicant - Fill out the entire page below and return to: File Community Development 401 McIntire Rd, North Wing, Charlottesville, VA 22902 Jody Halloran "` �jody.halloran@vafertiliry.gom A 4jl=1: 00 Olympia Circle Suite 201 Charlottesvi,V2911 4100 Olympia Circle ' ;434220-8826 t I suite 201 Charlottesville, VA ` 22911 c � ,.k,l, R%^rc M, Vlrgi Is Land Company L e. p0 Box 8147 Charlottesville, VA 22906 New Business ❑ Change of use Change of Ownership Change of Name r ,.q J` Describe the business including use, number of employees, number of shifts, availability of parking, and any additional in we are a private medical practice that specializes in fertility services, we have 28 employees, operate 7 days a week, one shift; we own the second goo the w mg an s are t e par ng aroun a roc an a o e ui mg wi t e rst oor usmesses 4 arH C$If�c y t41P?St'I _ � none ri 4r lii�l r�x:: Please attach either an architectural drawing or a sketch of the proposed_4wdrness Indicating the location of uses, the uses of rooms, the total square footage of the use, and any addifi) ' ormation. 10,200 % Yl�^_ Q_) • N . r � hs ^s;za 1H �;p Yes ®No If yes, fill out a Certified Engineer s Report 'CER1 ` YF ttt K y' a x 1 taw 4: Yes ® No If yes, provide Virginia Department of Health approval EiPublic Private If on private well, Provide Virginia Department of Health approval ❑X Public ❑ Septic If on septic, provide Virginia Department of Health approval 4e .H . I e ��ia�'t � 3 t' � ® Yes No If yes, obtain appropriate sign permit and list permit # below , � i I� Yes � No " 7 'P'�'r If ,77�3b ,,.! ,+�. ed,�t q k�`srr �� ,�� fi, yes, obtain appropriate building permit and Ilst permit #below sw Q 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 I will abide by them. Signature =2PIAA44 (2)(1 l Printed Jody Halloran Date 141" Zoning Clearance Application 401Mm rlR N.MW Albemarle e Count Y a01MGnCree, Nm 9`2 CmrlOttssville, VA 22902 PnOm 4 1,291!sB32 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, Virginia Fertility 8 IVF [,'C 710ZI f q clearance number provided by Staff or business name to Virginia Land Company the owner Name of landowner on record of Tax Map and Parcel Number 78-11 and C2100 by either delivering 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 D Mailing a copy of the application to the owner identified above on Date 11/4/21 to the following address: PO Box 8147 Charlottesville, VA 22906 (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 �+r'e�i�i `y� Applicant Name Printed 4 Jody Halloran Date 1114/21 For Albemarle County Staff Review Only l" L d � � o IC2 r*s' Yee ❑ No �°tu°d-xu -e_ Zyt z, C z _. � �zGrozl �3 "E";" fop?-O/p-2 Ldird o rMP 78'l� : �l `C ✓Ge If there is an a off approved site plan associated with the parcel, the parking requirements will be finetl by the SD .Some parking requirements are determined by a ZMA by ry K x. or an a roved Code of Development. n 5� ? Z(fQ ite Plan ❑Zoning ordinance ❑ Coo ❑Existing �k 5�7 zol6�Ss � 4 +'rF.n {�y.,,.e1 f%.IMv'Ail �'1 f ti` 2 M�J .H 4 rdi°Ptl it•' i ❑ Yes ❑ No rani a: a LIVIV 06,f qv SjD�Ge i1 l31 �Q� Z r c r r� r� s Pzo�6-�5 • i n ; TP�"fa7„F r' Additional conditions of approval apply to Fireworks and Christmas Trees t } >14'eIVILIK tk0VYrM! 5Wr-jL/Lt` L(S v-eB ✓F1vI� &- V & 3 ` I� �Iertig1 5�6rs✓,j V�tGQ�7gl SG2S'fol7� J Zvi Appryal Information Approved as proposed, ❑ Approved with conditions ❑ Denied . ❑ Backflow prevention device and/or current test data needed for this site. Contact ACSA, 434.977.4511 ext. 117 ❑ 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. Building Official 0- Date Zoning Official i Date l Z -6- Z / I Other Official Date County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Phone: 434.296.5832 Pax: 434.972.4126 6u aaui6u3 = d a aea xlox" n �.�r Ja�3H5 aaAOJ _ H d 4 u", � v i r n Vz/r � �suuLLnu �^ vn '.uHna� a7arnaa7v •.�ia�,siH rerrvva� 2I81N83 and xnd a6s aYxid Vu/ .wanew awnm z Ne/ �,„ . „ W cc L <v dW T 0 Z 0in0 IM LLIG7 Qa rr• �Z�� C > F J c Q g s a ® & o Pg¢� �6�tlF �= SSAGEiS:: ytly • Qi iFe Y P ; e p®q78 ; 9jq ° g SpS �p49j y€ 9p Y9° y �e Y Y8 d�e 9 0 il[;918/Ni�.� g f!2 !ge tl. 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