HomeMy WebLinkAboutCLE201000010 Review Comments No Submittal Type Selected 2010-01-28- - Ap- peaton for Zoning - Clearance
- -- - 21 -Zon-ing- Clearance = $3-.5 -
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY _� / r
Check# - - -, - SU Date:
Receipt # Staff: f,(/
PARCEL INFORMATION
Tax Map and Parcel: 076M1 -00 -00 -01200 Existing Zoning
Parcel OWner:Five Springs, LLC
Parcel Address:1201 Stoney Ridge Rd, Ste 4 City Charlottesville State VA Zip 22902
(include suite or floor)
PRIMARY CONTACT
-- Who- - should we -call/ write - concerning this project? Medical- Services -of- America, Inc. - - -
Address :PO Box 2431 City Lexington State SC Zip 29071
Office Phone: 8( 03) 957 -0500 Cell # Fax # 803- 358 -1733 E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name X New business
Business Name /Type: Medical Services of America, Inc. d /b /a Medi Home Care
Previous Business on this site
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicles, and any additional information that you can provide: Sales and rental of Durable Medical Equipment. Hours of
operation are M -F from 8am - 5pm.
*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 pennission to use the space indicated on this application. I also certify that the infornlation provided
is true and accurate to the best of my lowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
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Signature Printed,L'�G(%Q/�a/
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APPROVAL INFORMATION
[ ] Approved as proposed [ App roved with conditions [ ] Denied
[ ] Backflow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, x117.
[ ] No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
site plan.
[ ] This ite coin lies with the site this to
Notes: p
Building Official Date' l�
T
Zoning Offici -Al Date, 'j - (0'
Other Official Date
t ounty of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 04/28/08, 10/13/09 Page 2 of 3