HomeMy WebLinkAboutCLE201300282 Legacy Document 2013-12-0391, A I'0Ll
Application for Zoning Clearance
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rr CLE # 2D 1 782-b
OFFICE US LY
PLEASE REVIEW ALL 3 SHEETS
Check # Date:
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Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: () %F00'yii - b0 - 3 d E Q Existing Zoning %j1 Ci
Parcel Owner: G__
Parcel Address: S O +e 2_60 City CVO Utb State VA- Z1pz_Z9 ( I
(include suite or floor)
PRIMARY CONTACT
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Who should we call/write concerning this project? 1/ c l�
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Address: 0 b0 R�cr �ef�. Okoji , 2-6a City. C�a40+1kWQ State V ZipZ2-cj I�
Office Phone: ddb 2CL(o• (nLf (p I Cell # Fax # 24&. °is Zq E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: 1 ' ��.i S 1 C f CkV K1 Ul(,P_mA 6P fi i f'kcv i ip.a.L II,,CcN
Previous Business on this site �SC-� �i� CkCLyj 6+-(fS h I ce (Sc u`eca6ci s:,
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: (SL r V\2 CO LOC(1 S-{- b EA'co . 3 S -6- FI=
6 pLo CL-C', -S eat' L C,07 te
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*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 acc ate to the best knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
/nof��my
Signature A Printed 1 (q 6 Let C(_P NL O
APPROVAL INFORMATION
'Approved as proposed [ ] Approved with conditions [ ] Denied
j ] 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:
j
Building Official Date E
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 7/1/2011 Page 2 of 3
Intake to complete the following:
Y /E
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y (N�
Will there 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 kpublic water?
If private well, provide 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 septic or ublic sewer?
Y/,NP
Will"you be putting up a new sign of any kind?
Sign permit.
Permit #
Reviewer to complete the following:
Square footage of Use:
)
_Y)/N
Permitted as: T�,�
Under Section:
Supplementary regulations section:
Parking formula: /
rya, N
Required spaces:
Y/
Items to be verified in the field:
If so, obtain proper
Inspector : Date:
Y / Notes:
Will t re be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Violations:
Y/A
Ifso, ist:
V ffers:
N
If so, List:
Variance:
Y/�
Ifso,List:
SP's:
Y/
If so'-, —List:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of
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� Charlottesville Gynecology, PC Gwendolyn V. Kelly, MD
November 22, 2013
To Whom It May Concern:
My name is Dr. Gwendolyn Kelly, and I purchased a condo located at:
600 Peter Jefferson Parkway
Suite 200
Charlottesville, VA 22911
Tax Parcel #: 07800- 00- 00 -030FO
It is under a company called "Health and Spa ".
I currently work as a gynecologist in a company called Charlottesville Gynecology.
As of January 1, 2014, I will be joining a group of physicians, and the new name of my practice will be:
"Charlottesville Gynecology, a division of Anchor health Care PLC ".
As such, I have been instructed to apply for zoning clearance from the County of Albemarle. Please find an
enclosed application as well as a check for $50.
Thank you.
Sincerely,
Gwendolyn Kelly, MD
600 Peter Jefferson Pkwy, Suite 200. Charlottesville, VA 22911 Phone: 434 - 296 -6461- Fax: 434- 296 -7529 www .charlottesvillegynecology.com