HomeMy WebLinkAboutCLE201000011 Review Comments Zoning Clearance 2010-01-281!
- Application fo-ylr Z�/F on n Clearance
-- - -_- _✓Zoning Clearance = $35.
OFFICE USE ONLY
Check - # -- - -- /0 ,r> Date:
PLEASE REVIEW: ALL 3 SHEETS
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: 076M1 -00 -00 -01200 Existing Zoning
Parcel Owner:Five Springs, LLC
Parcel Address: 1201 Stoney Ridge Rd, Ste 2 City Charlottesville State VA Zip 22902
(include suite or floor)
PRIMARY CONTACT
Who- should -we -call/ write- concerningthis project? Medical - -Ser- vices -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: Medi Home Health Agency, Inc. d /b /a Medi Home Health and Hospice
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: Provide In -Home Hospice Care Services. 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 permission to use the space indicated on this application. I also certify that the information provided
is true and accurate to the best my owledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
OW
Signature G Printed aQN `' �
i
A ROVAL INFORMATION
[ ] Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, xl 17.
[ ] 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.
Notes:
Building Official c -; Date p / 1I IIi oa
Zoning Official Date 1__V L
Other
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 04/28/08, 10/13/09 Page 2 of 3