HomeMy WebLinkAboutCLE201800249 Approval - County 2022-06-22( L1
Application for ZoningClearance
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check# 2 01 I Date:
1111eceipt.# Staff:
PARCE1 INFORMATION
Tax Map and Parcel: 03200-00-00-041 D1 Existing Zoning PDSC
Parcel owner..Timberwood Commms LLC
Parcel Address:1620 Timberwood Blvd., 1 st Floor City Charlottesville State VA Zip 22911
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? Owner I Reid Murphy
Address :400 Locust Avenue, Suite 3 City Charlottesville State VA Zip 22902
Office Phone: (434) 977-6400 Cell # 434-825-1560 Fax # E-mail reid@bmcholdingsgroup.com
APPLICANT INFORMATIOON Owrter on behalf of Tiertam
Check any that apply:_ Change of ownership Change of use Change of name X New business
Business Name/Type: Charlottesville Orthodontics / Orthodontics
Previous Business on this site N/A
Describe the proposed business including use, number of employees, number of shifts, available parking s aces, number of
vehicles, aad any a+ibOki{wanw in&rmation chat you cam provide: 94054 s� 4 ro.Ce-- oin0.\ ®fjp' e-e t
4-C� e-w.�ley -es 1 shr� F , S3 Qnt_ k� spaces an sT1t Z1�� sF acts
j
cicro5S caal rcels
"This Clearance will onl 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 � have the owner's permission to use the space indicated on this application. I also certify that the information provided
is true and accurate o th bes of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed 'r4-Mttaphyn S. r'Lr--1/(r • Iq
1
PROVAL INF RMATION
] Approved as proposed - [ ] Approved with conditions [ ] Denied
$A
j Backflow prevention device and/or current test data needed for this site. Contact ACSA, 9774511, x 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.
1 eem.
Building Official Date
Zoning Official Date 1�1�
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:
Is
Is usin LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /(N /
WiII R@ be food prepaRatwn?
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 orCblict ?
If private well, provide Healment form.
Zoning review cannot begtwuntil we receive approval from Health
Dept. FAX DATE
Circle the one that applie
Is parcel on septic or p btc sewe .
Y/N
Will you be putting up a new sign of any kind?
Sign permit.
Permit #
Reviewer to complete the following:
Square footage of Use: 9\ J
Y/N
Permitted as: 1 1CA2
Under Section: (J)
Supplementary regulations section:
Parking formula:
I/ I r net
Required spaces: . w
It/ J
Item be verified in the field
If so, obtain proper
Inspector: Date:
Y / N Notes:
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zonine to complete the following:
Vio s:
Y N
If so, is[:
Proffers:
Y/N
If so, List: n non - — G 2
� tl iiW
Var' n e:
Y / N
If so, ist:
SP'P�^��/
Y (
If so, List:
Clearances:
SDP's
Revised I1/l/2015 Page of
CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
This form mnat accompanP z0n"1g ap#fca6otes (Nome 0,capadon, Zoning (-learance, Zoning
Administrator Determination% or Appeofs, Sign Permits, Banding Permits) if the apprwaftw s am the
owner
Qwner o c�mcQrt
I certify that notice of the application,
[County application name and number)
was provided to jnar_ the owner of record of Tax Map
rte(s) of the record owners of the parcel]
and parcel Number _
manner identified below:
delivering a copy of the application in the
Q14and 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 erttity, idemfy the recipient of the record and the recipient's
title or off -ice for that entity)
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 recipients 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 ]rooks or current real estate tax assessment records satisfies
this requirement).
Signature of Applicant
print Applicant Name -- — ---
Date
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