HomeMy WebLinkAboutCLE201400117 Legacy Document 2014-06-20Application for Zonin Clearance
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY f$�', 7 L
Check # 1 b0 (e Date:
Receipt # Staff-
PARCEL INFORMATION
Tax Map and Parcel: 061 WO -01 -OA -001 CO Existing Zoning C1 Commercial
Parcel owner: Freedman Properties, LLC c/o Dr. Richard S. Freedman
Parcel Address: 445 Westfield Road City Charlottesville State VA zip 22901
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? Joanna Nortmann, DVM
Address: 445 Westfield Road City Charlottesville state VA zip 22901
Office Phone: 4( 34) 973 -6146 Cell # Fax #434- 293 - 4159E -mail Joanna .nortmann @petpartnersusa.co
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: Albemarle Veterinary Health Care Center /Animal Hospital "� /E lJLI'• zU�;✓
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: This permit will serve as permission for an open
house event utilizing our parking lot.
*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.
Signatur Printed Of(hnrb % uamk\ } ®L/M
APPROVA 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
Zoning Official Date &"b g/Za A)
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 /I0
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /Q
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 or ublic ter?
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 app1
Is parcel on septic or ltublic sewe ?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: P,4 V,k
&/N v
Permitted as: J�� 1p -LVCA
Under Section: c Wl iN , V i C,
Supplementary regulations section:
Parking formula:
Required spaces:
Y/
Items o be verified in the field:
Inspector : Date:
Notes:
Viola ons:
Y/Q)
If so, List:
Proffers:
Y/
If so §ist:
Varia ce:
Y/
If so, ist:
SP's:
Y/6
If so, List:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3
CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
This form must accompany zoning applications (Home Occupation, Zoning Clearance, Zoning
Administrator Determinations or Appeals, Sign Permits, Building Permits) if the application is not the
owner.
I certify that notice of the application, Zoning Clearance
[County application name and number]
was provided to Freedman Properties, LLC (Dr. Freedman) the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number 061 WO -01 -OA -001 CO by delivering a copy of the application in the
manner identified below:
X Hand delivering a copy of the application to Dr. Richard S. Freedman
[Name of the record owner if the record owner is a
person; if the owner of record is an entity, identify the recipient of the record and the recipient's
title or office for that entity]
on 6/18/14
Date
Mailing a copy of the application to
[Name of the record owner if the record owner is a person;
if the owner of record is an entity, identify the recipient of the record and the recipient's title or
office for that entity]
on
Date
to the following address:
[address; written notice mailed to the owner at the last known address of the owner as shown on
the current real estate tax assessment books or current real estate tax assessment records satisfies
this requirement].
i ature of Applicant
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Print Applicant Name
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Date
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