HomeMy WebLinkAboutCLE201100027 Review Comments Zoning Clearance 2011-02-04/N'
Application f ®r Zoning Clearance
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CLE # B11 _ 2
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONL ,
Check # Date:
Receipt # Staff: ^ 1, c
PE1 R rEL !NFOR M—A- TT()N
Tax Map and Parcel: V ve - — l.G Existing Zoning /
Parcel Owner : IN-olu,5du o f V i r %lvd/? fO 9 n / hd
Parcel Address: f� �� ity I V [i !�� State Y o ` Zil
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? HA rl y-OV&
Address: 51 k1 zP0VW-00e (P) City Cy1 V if State ✓A Zip2z9o3
Office Phone: 6� ) N I A Cell #4S44(AP9S63 Fax # h E -mail 1i1 y %l'i`t 0 0 gVVlai e
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: I VI 1!�A w l by M4.011rr i ne 1714
Previous Business on this site
Describe the proposed business including use, number of emplo es, number of A ' s, available parking spaces, number of
vehicles, and any additional information that you can provide: Um11y 'A 0C o M Le $, 5 1 -5 Ye VIK I-e3
*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 be of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature �°°®°°° Printed
APPROVAL INF IO
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 Z)—( L( t i
Zoning Official Date
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 1/1/2011 Page 2 of 3
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Intake to complete the following:
Y /c,
Is use m LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y / N .
Will sere be food preparation?
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 or ublic water?
If private well, provide Hea r went form.
Zoning review can not begin until we receive approval fi•om Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic or pi lic sewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sig ;permit.
Permit #
Y' /N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7nniner to vmmnlPtP the fnllnwin¢-
Reviewer to complete the following:
Square footage of Use: �w
vY / N n
Permitted as: Auk'4'
Under Section: '— , ' 2- I
Supplementary regulations section:
Parking formula
Required spaces:
Y/ j
Items o be verified in the field:
Inspector : Date:
Notes:
Violations:
Y ro
If so, List:
Prof a s:
Y /
If so, fist:
lj
1'. Variance:
Y
If so; List:
SP's:
Y /
If so, ist:
Clearances:
SDP's
6 7
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Revised 1/1/2011 Page 3 of 3
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EXHIBIT "A"
Attached to the Lease Agreement between the UVA Foundation and Ivy Family Medicine, PLC dated t q,2010
PREMISES FLOOR PLAN
493 RSF, Suite 130, 2 Boars Head Place
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