HomeMy WebLinkAboutCLE201400122 Legacy Document 2014-07-07Application for Zoning Clearance
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PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Receipt # Staff-
PARCEL INFORMATION G
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Tax Map and Parcel: 0 Existing Zoning
Parcel Owner: Lint\ L1 tws\_'
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Parcel Address: 141b �v g, M42 b AA I h D City W �l� U-A State U4, Zip9'VV
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? 9TIA0 n • '��dwALT(v MID
Address : IL M) L\\t qnk). Qu
. Sa c, wb City Cywk(At Xk State Zip ZIA)
Office Phone: (_J Cell #TM1151 fltb Fax # E -mail 6V11k r�kt
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: hba6tAk1b NI XU c5�11rC1,
Pr�eus usiness on this site QVU, S'UtU�Un.� �TSbUvCf�S txnw�lo Q,SV��� Q`� 1031 t E7(1a
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Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicles, and any additio al information, at you can rovide:
is
*This Clearance will only be valid on tA parcel for whicU it is approved. ffyoW change, intensify or Aove thcDse & 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 owledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed QfL19+•� W VQ
APPROVAL INFORMATION
as proposed [ ] Approved with conditions [ ] Denied
IApproved
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 .�L. -� . Date �. c_ ('-(
Zoning Official 4 A Date _ _ % z 7! 7', iq
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
Is use in LI HI or PDIP zoning? If so, give applicant a Certified
Reviewer to complete the following:
Square footage of Use: Z / b!j
Engineer's Report (CER) packet. / N
Permitted as : 6 T / U �� c v
Will there be food preparation? Under Section: " / ;� •3
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 - = --�
Is parcel on private well r public wat ?
If private well, provide He p ment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applied--- -
Is parcel on septic or p bhfi c sewer)
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:
Parking formula:
Required spaces: 4K
Y /lb
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
Y/
If so, ?-St*
Proffers:
62/N
If so, List:
Variance:
N
If so, List: V11 1 180' �3
-7
SP's:
0/ N
If so, List:
Z L.'2..
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3
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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,
[County application name and number]
was provided to ) 06\ u 0.'i- the owner of record of Tax Map
[name(s) of the r cord a4mers of the parcel]
and Parcel Number
manner identified below:
—V Hand delivering a copy of the application to
by delivering a copy of the application in the
[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
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].
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Signature of Applicant
&\w - FA v', eya
Print Applicant Name
Date
Board Certified
Vascular Surgery
John Ligush, MD, FACS
Lewis V. Owens, MD, FACS
Office:
1490 Pantops Mtn Place
Suite #100
Charlottesville, VA 22911
Phone (434) 244 -4580
Fax (434) 244 -4579
www.cdsu[gical.com
Manager:
Christine C. Jorgowsky
TOTAL
VEI CARE
IC
MoratorJ
Affiliated with
Martha Jefferson
Vascular Center
Vascular Surgery
June 19, 2014
To Whom It May Concern:
I am the building owner of 1490 Pantops Mt. Place, Suite 100, Charlottesville,
VA 22911. I am aware that Dr. Showalter will be applying for zoning in our
building/ office.
If you need any further information regarding this matter please
feel free to contact me at 434 - 244 -4580.
Thank you
Jo e-
M.D.
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