HomeMy WebLinkAboutCLE202000169 Approval - County 2022-06-22Zoning Clearance Application
FOR OFFICE USE ONLY
Fee Amount: $ 54
Clearance Number: Cke,,',Q� Kt
Date Paid: 1af a ilaG
Receipt #: LA ii a7i 6 8 is �5(6
Applicant - Fill out the entire page below
And return to Community Development 401 McIntire Rd, North Wing,
3"'2
Albemarle County
Community Development
401 McIntire Rd. Norh Wing
Charlottesville. VA 22902
pPhone 434.296.5832
By: QCrO, VenX 0VED
by the Albemarle County
By: mmun
ih Development Department
ate _�-� 1�
File eUFZo�.p l67
Charlottesville, VAAA�290Z—
Name:
Health Connect America
E-Mail Address:
Mailing Address:
485 Hillsdale Drive Suite 306, Charlottesville, VA 2290'
Phone #:
434-806-7707�`f0.'
Tax Map and Parcel
number and/or Address
of the Business:
485 Hillsdale Drive Suite 306
Chrlottesville, VA 22901
Zoning:
Staff willfillouti/unknown
f _
6 l
481 Hillsdale Drive Suite 100
Parcel Owner:
Ja-Zan, LLC
Owner's Address:
Charlottesville, VA 22901
Check any that apply:
New Business ❑ Change of Use Change of Ownership ❑ Change of Name
Business Name:
ealth Co . nnectAINIMInc.
Description of Business:
Describe the business including use, number of employees, number of shifts, availability of parking, and any additional info.
Private counseling agency, 10 in -office employees, office hours are Monday-Frida, 8:00am-6:00pm
Parking is available in the lot outside of the building, there is an elevator and two sets of stairs on each side of the building
Previous Business on Site:
Alzhimer's Association
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:
3,000
Is the Parcel Zoned LI, HI, or PDIP?
Yes No If yes, fill out a Certified Engineer's Report (CERj
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?
propriate ppropriate sign permit and list permit #below
El Yes M No If es, obtain ap
Will there be new construction or renovations?
❑ Yes *1 No If yes, obtain appropriate building permit and list permit # below
Please list any applicable Building Permit #s:
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 t I will abide by them
Signature v Printed YC./ lJln `le.x(d tlF
Date l
2
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M
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Albemarle County
Zoning Clearance Application Common,yeeveNorth ,
407 Mclnlire Rd. North Wing
Chadofteevlle VA 22902
Phone 434.296.5832
Applicant - If you are not the landowner, please fill out the entire page below, confirming that you have either
informed or are going to notify the owner of your 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,
to
of Tax Map and Parcel Number
Health Connect America, Inc. ( (r E ZaLO-- 16 9
LLC
061W0-02-00-002A2
the owner
by either delivering a
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
li? Mailing a copy of the application to the owner identified above on
Date to the following address:
481 Hillsdale Drive, Suite 100, Charlottesville, VA 22901
(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
3
For Albemarle County Staff Review Only
Proposed Use:
664L-e
Permitted:
es ❑ No
Permitted by Section:
I 2 Z 4Zt
Supplementary Regulations:
�—
Applicable Special Use Permit (SP):
Applicable Rezonings (ZMA):
Applicable Site Plans (SDP):
l l ®�- Z6
Parking:
If there is an approved site plan associated with the parcel, the parking requirements will be defined by the SDP. Some
Parking Formula:
VZ,-00
Defined by: I
FL46te Plan [-]zoning Ordinance ❑ CoD ,❑Existing
Total Square Footage of the Use:
ezio f
Required number of parking spaces:
D
lZ $ 4C,eps G,/C (eS vVvt p D
Associated Clearances:
tt
2 Oi 3 2 ZBtl 7 )IfJ
Variances:
Violations:
Is a site inspection necessary?:
❑ Yes ❑ No
Site Inspection on (date):
To Confirm:
Notes:
Conditions of Approval:
Additional conditions of approval apply to Fireworks and Christmas Trees
Approval 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.
Conditions:
Additional Notes:
Building Official l
Date
Zoning Official
Date IL- i2-0
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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