HomeMy WebLinkAboutCLE201000241 Review Comments Zoning Clearance 2010-11-24ATTENTION: JENNIFER DURRER
Application for Zoninp Clearance
Z
it-
CLE # I
OFFICE /1
;2
Z7 9 ��11
E] Zoning Clearance = $35
Checic # Date:
PLEASE REVIEW ALL 3 SHEETS
Receipt # Staff.
PARCEL INFORMATION
- - - 06100- 0.0 -00- 12300_ PDSC
Tax Map and Parcel: - -__ - Existing Zoning
Parcel Owner: RIO ASSOCIATES LIMITED
Parcel Address: 422 ALBEMARLE SQ City CHARLOTTE SVILIAte VA Zip 22911
(include suite or floor)
PRIMARY CONTACT
DIANE EASTMAN
Who should we call /write concerning this project?
Address : PO BOX 2407 City SKYLAND State NC Zip 28776
Office Phone: ( 82� 277-1300 Cell # Fax # E -mail
APPLICANT INFORMATION
Check any that apply: X Change of ownership Change of use Change of name New business
Business Name /Type: ALLERGY PARTNERS PA dba ALLERGY PARTNERS OF CHARLOTTESVILL
Previous Business on this site VIRGINIA ADULT AND PEDIATRIC ALLERGY
Describe the proposed business including use, number of employees number of shifts available parkin sppaces number of
PRACTICE; 3 EMP1g0YEEY ON TUE
vehicles, and any additional information that you can provide: 1�'lE1�ICAL
S_Q�
THURS ONLY; DAY SHIFT ONLY; FLOOR -PL ; 1500
*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 abide by them.
of
Signatur �� -e--( / �' �-� Printe� t CAniE ��sTm t��
APPROVAL INFORMATION
Approved as proposed [ ] Approved 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 site complies with the site plan as of this date.
Notes:
Building Official Date L l r �3 (
Zoning Official Date O Z /h,
Other Official Date
County of Albemarle Vepartment of uommunity ueveiopment
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
J
1=
Intake to complete the following:
Reviewer to complete the following:
Y
Square footage of Use:
Is un LI, HI or PDIP zoning? If so, give applicant a Certified
O / N
Engineer's Report (CER) packet.
p l
Permitted as:
Y /
Will there be food preparation?
-� )
Under Section: � — • I
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from Health
Supplementary regulations section:
Dept. FAX DATE -
Circle the one that applies
Parking formula:
Is parcel on private well o c w ter?
If private well, provide He artment form.
Zoning review can not begin until we receive approval from Health
Required spaces:
Dept. FAX DATE
Y/N
Circle the one that ap
Items to be verified in the field:
Is parcel on septic r public sewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Inspector : Date:
Notes:
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Pen-nit.
Permit #
Z,nninu to emmplete the following:
Violations:
Y /N
If so, List:
Proffers:
Y/(P)
If so`�ist:
Vari nee:
Y / lid
If so, List:
SP's:
/ N
If so, List:
Clearances:
SDP's
Revised 04/28/08, 10/13/09 Page 3 of 3
j
-v_ _.. _