HomeMy WebLinkAboutCLE201500076 Application 2015-05-04Application for Zoning Clearance
IS- - � & CLE #
0—
OFFICEUSE ONLY
PLEASE REVIEW ALL 3 SHEETS
Check # o �3 S" Date: Lt ' a " L ' l S
Receipt # 99 S'`'td( Staff: 56Z__
PARCEL INFORMATION 1
Tax Map and Parcel: _ _ Q61 W o-- o 1 — (DA —o ok o0 C3 Existing Zoning
Parcel Owner:C��C \ 5A a )7 F'\-2<— c 0y_e �
Parcel Address: 441 WESTFIELD RD City CHARLOTTESVILLE State VA Zip 22901
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? LINDSAY ROSENBLUM
Address: 1950 OLD GALLOWS RD STE 520 City VIENNA State VA Zip 22182
Office Phone: ( 703) 847-8899 Cell # Fax # E-mail LROSENBLUM@MYEYEDR.CCJ
APPLICANT INFORMATION
Check any that apply: x Change of ownership Change of use Change of name New business
Business Name/Type: MYEYEDR OPTOMETRY OF VIRGINIA, LLC-WESTFIELD RD
Previous Business on this site CHARLOTTESVILLE FAMILY VISION CENTER
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:
OPTOMETRY, 11 EMPLOYEES
*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 accura a to the best of my knowledge. I have read the conditions of approval, and I un�d/erstpa�nd them, and that I will abide by them.
Signature d Printed 4itit 0_ 1 c « S
c
APPROVAL INFORMATION
Approved as proposed [ ] Approved with conditions [ J 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 —1 LZ
Zoning Official Date �Z2
Other Official Date
____kC0Unty of Albemarle De artmt of Community Development
401 McIntire Road Charlottesville, VA 22902 oice: (434) 296-5832 Fax: (434) 972-4126
Revised 7/1/2011 Page 2 of 3
N
Intake to complete the following:
Y 13
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y/�
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 orCub1:ic;w?aer?
If private well, provide Heaent form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that aptpufblic:se:w?e.
Is parcel on septic o
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: 3761
(-�)/ N p n
Permitted as: 'M er.0 i v9� d T-1 ce-
Under Section: 2-2— • 2
Supplementary regulations section:
Parking formula:
Required spaces: 1-5,
Y/
Items to be verified in the field:
Inspector : Date:
Notes:
Viollt�ions:
Y/k
If soYiist:
Prof s:
Y/
If so, ist:
Varig e:
Y/1/
If so, List:
SP's:.
Y/�I
If so, List:
Clearances:
SDP's �7
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,
was provided to
[County application name and number]
[name(s) of the record owners of the parcel]
and Parcel Number
manner identified below:
the owner of record of Tax Map
by delivering a copy of the application in the
Hand delivering 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
Mailing a copy of the application to Dr. Christopher Covert
[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 4/21/2015
Date
to the following address:
1860 Tinkers Cove Rd. Charlottesville, VA 22911
[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].
Signature of Applicant tl
Print Applicant Name
Date