HomeMy WebLinkAboutCLE202300033 Application 2023-03-17Zoning Clearance Application
ICE USE O hi - Clearance Number: ,. -
61 36 date Paid: By
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Applicant - Fill out the entire page below, and return to:
Community Development 401 McIntire Rd, North Wing, Charlottesville, VA 22902
Albemarle County
Community Development
_ 401 McIntire Rd,, North Wing
Charlottesville, VA 22902
Phone 434.296.5832
w@" w°k�3t, Charlottesville Orthopedic Center PLC E�Maq Address: DA Vc
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Mailin ipddrae�„ 183 Spotnap Rd - Suite C 00,130" ,t - 434-244-8412
TM-78-15F om I ax map anq gat, �v ng:
n� int ler and/or Age �Steff will fill out if unknown
of I?he t3uslttesss,�' -' �"
Parcel Dwnar, .' Pantops 183 LLC owner sAddresr. _: 195 Riverbend Dr - Cville 22911
Check *that appfy -, ❑ New Business'. Change of Use D Change of Ownership Charge of Name
Business Iuame 4 Charlottesville Orthopedic Center PLC
De$Crlptlon of,B}]slErFs$:'. Describe the business including use, number of employees, number of shifts, availability of parking, and any additional info.
AA4i-ir)ICAS-o !CC- 9u(L-61/o6 0Q1-PA1Ec1Jer-
Previous Bus�rg$s>,Sr- Heartland Hospice
FIOOr Plan - 5' 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.
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the Busin)as
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Is the Parcel Zoned U. Hl,.otr
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❑ Yes
X No
If yes, fill out a Certified Engineer's Report (CER)
WIII there be faoptrz !
❑yes
No
If yes, provide Virginia Department of Health approval
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Public
❑ Private
If on private well, provide Virginia Department of Health approval
IS the?Farce l on p41wea eFAl Setfti1
Public
Septic
If on septic, provide Virginia Department of Health approval
❑Yes
No
If yes, obtain appropriate sign permit and list permit # below
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Wilt there �e i Ott r. ra"evatlrina"?;9
Yes
No
if yes, obtain appropriate building permit and list permit #below
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B2023- 213AC
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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 I will ab' by them.
Signature - Printed N 1 j"6�
Date 2� 23 2
Albemarle County
Zoning Clearance Application Community Dad, North
Development
Charlottesville,
McIntire Rd, NorthD2
_ Charlottesville, VA 229D2
Phone 434.296.5832
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 Pantops 183 LLC the owner
Name of landowner on record
of Tax Map and Parcel Number TM-78-15F 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 3-15-23
❑ Mailing a copy of the application to the owner identified above on
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
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