HomeMy WebLinkAboutCLE200600173 Legacy Document 2014-08-20Application for
Zoning Clearance
FZoning Clearance = $35 1
PLEASE REVIEW ALL 3 SHEETS
, W 17 J
Tax map and parcel: 06100000012300 (C ( ` l 9_� Existing Zoning:
Parcel Owner: Dumbarton Properties /RioAAsso6iates Limited Partnersh
Parcel Address: 412 -414 Albemarle Square CityCharlottesville
(include suite or floor)
State VA
PDSC
Zip22901
Contact Person (Who should we call/write concerning this project?): Dr. Greg Degnan /Dean Martinelli, CPA
Address P. 0. Box 1408 City Charlottesville State VA Zip 22902
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Daytime Phone CA3� 296 -2156 Fax# 4( 34) 977 -4629 E -mail dmartinelli @hantzmonwiebel.com
Business Name /Type: Atlantic Coast Orthopaedic Specialists, PLC
Previous Business on this site: Not known
Proposed use: Physicians Offices
SEE CONDITIONS OF APPROVAL IF THE CLEARANCE IS FOR FIREWORK OR CHRISTMAS TREE SALES (Sheet 1)
Circle (if applicable): Fireworks / Christmas Tree
*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 ow or have the owner's permission to use the space indicated on this application. I also certify that the information
provided is true and accur to e best of my knowledge. I have read the conditions of approval, and I understand them, and that I will
abid by them.
mob? / &-6
mig,ftjture of usi ess 64ner or A ent Date
Tyr. Greg Degnan
Print Name Backflow Device and/or'
APYROVAL INFORMATION
[ VApproved as proposed
{ Contact ACSA 977.4511, x 119 { JUL 13 2006
[ ] Approvea WITH -M
[ ] Backflow device and/or current test data needed for this site. Contact ACSA 977 -4511, x119. COMMUNITY DEVELOPMENT
[ ] No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing site pan.
[ ] This site complies with the site plan as of this date.
Building Official _ Date -A 1i
Zoning Official Date 3! O b
Other Official I Date
FOR OFFICE US) `ONLY CLE #
Fee Amount $ Date Paid �y who? & ceipt _ Ck# l By: Z /� l
t
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 511106 Page 2 of 4
Applicant to complete the following:
Do you have one of the following?
® YES ❑ NO
Tax Map and Parcel Number and or;
Address of use (include unit or floor if appropriate)
® YES ❑ NO
Do you have a Floor Plan (sketch or an architectural drawing) that
includes the following, and if so please provide it with the
application?
The total square footage of the use and /or;
The square footage of each room or area of use;
Use of each room or area
If using less than the entire structure, note the location within the
structure.
Tech to complete the
Violations:
❑ YES NO
If so, List.
S b - 2OaZ - -17
e:
Va 'anc
[MS ❑ NO
If so, List:
ANl d�r`i� A
Intake to complete the following:
❑ YES 0,4/0
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
❑ YES Z,4/0
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
❑ YES ❑ O
Is parcel on ivate well and septic?
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from
Healt ibept. FAX DATE
7YES ❑ NO
Is on public water and sewer?
❑ YES
Will you be utting up a new sign of any kind? If so, obtain
proper Sign permit.
Permit #
❑ YES 10,/0
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
❑ YES [�O
Is this for sales of Fireworks?
If so, obtain a copy of F/R permit.
Permit #
L •
If sd. List:
SP's:
❑ YES PNO
If so, List:
511106 Page 3 of 4
Reviewer to complete the following: '�36w
Square footage of Use:
UL -YES ❑ NO
Permitted as: ML49 11
VV
Under Section: 02�• 01- I (i� 23 +a. ! ���
Supplementary regulations
,� section: YVV-
Parking formula: / 0;�
Required spaces:
❑ YES ❑ NO
Items to be verified in the field:
Inspector Name & Date:
Notes
5/1/06 Page 4 of 4