HomeMy WebLinkAboutCLE201200254 Legacy Document 2012-12-14Application for Zoni Clearance � ` " ;�
Z-A11- ng ��
OFFICE U�SFOl1v;�Y
PLEASE REVIEW ALL 3 SHEETS Check # I ( G�� Date 12 q " (2
� —
PARCEL INFORMATION Receipt # Staff:
Tax Map and Parcel: Existing Zoning
Parcel Owner: —U 1 N j lI
Parcel Address: City 0- kar Lo I Lit,, ,// State U. /;
(include suite or iioor) l �7
cuT°t_ �
PRIMARY CONTACT �q
01
Who should we call/write concerning this project?
Address: City < 4c_r v; /f& State
Office Phone: Cell # Fax # �jlo E -mail �C
APPLICANT' INFORMATION
Check any that apply: Change of ownership Change of use Change of name -Y' New business
Busin ess Name/Type: iii 1 oY�IL LF'kgL yI zbUl+NLZ h '7-L- r- IYWo Z-o C-L/L S
Previous Business on this site y, rq , ,� ti �� �� �ee(. L
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:
provid e: �� �C_
L-t O t m
5 / I,- 1 1.11
*This Clearance will only be valid on the parcel for �yhich it is approved. Ifyou 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.
Signature l Un Printed _�te_ �0
APPROVAL INFORMATION
f 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 r� Date
Zoning Official ` t-u-c �[�' 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 7/1/2011 Page 2 of 3
Intake to complete the following:
Y /0
Is use in LI, HI orPDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Reviewer to complete the following:
.)_l S,-
Square footage of Use:
/ N
Y /(0
/
ennitted as: h U Si n,c.55''
Will there be food preparation?
If so, give applicant a Health Department form.
Under Section: -1 .l
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Supplementary regulations section:
Parking formula:
�il ti
C ircle the one that applies
- - -- - - --
Is parcel on private well o public water?
If private well, provide Health Department form.
Variance:
Y/i)
If so, List:
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Required spaces:
Circle the one that applies
Is parcel on septic or ublic sewer?
Item to be verified in the field:
Y /N�
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Inspector : Date:
Y /(T
Notes:
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to comnlete the fnllnwina-
Viola��ons:
Y /IVJ
If so, ist:
rollers:
/N
so, List:
Variance:
Y/i)
If so, List:
SP's•
Y/ IO
If so, List:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3
62' -11"
9' -10" 9' -10" 5' -0 1/2"
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12' -4 1 /2" 12' -4 1 12"
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11'-11" 11' -O 1 12" — —0 10'-0 112".
3'
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-- 25' -4 112" 1
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5' AT HOME CARE ADVANCED
TEHNOLOGIES o z
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10' -I I/2" :E = � J
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5' -9" f —5 -3 1/2 "— ��7' -5 112" 3' -10 1 ' 3' N
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UTILIT F-1 A R
/ — 14'_6" lk
IB' -4"
8'
0 AT HOME CARE STA FING 15' -6"
/ SUITE B
Ff 3
date : 07/20/12
revisions
4' lo" /18' -1 vz" EXHIBIT "A"
a�- ArT''HG'ME°CAREADVANCED TEHNOLOGIES
195 RIVERBEND DRIVE sheet tille:
SUf.TS 4. "A"',
1478 SF
FLOOR PLAN
CONFERENCE ROOM
FIRST FLOOR
3/16' =1' -0"
sheet
A-1
of sheets