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HomeMy WebLinkAboutCLE201500085 Application 2015-05-072015 -May -01 03:10 PM Augusta Health Plant Ops 5403324769 2/6 ,Application for .Zoning Clearance cu # — SSS PLBAU REVIEW ALL 3 SHE, FITS ORFICS 11BT ONLY Chccir # A 3©`467 "l . DWI 5-6� 1 Racolptp C101 69'3 Staff, PVTC— PA.ItCLrL INFOR ATION Tnx Map and Pnrcol; rM SG P1 J 0 Existing Zoning r4ZGHWAY Coo lkle?UAL Pnrcol Ownara h?ReSTMt J 0. STALL DUGS Pnrcol Address., 5T&5O� 540 RAQr*t�L1YCIty Gf�p i- state Zip + Gy3 (include suite or floor) PWMA.RY CONTACT who should we cell/write concerning this projeot7 /906(2593 8581,114 F/ CZ14716 5 Address t 78A49DirCAe. Ct,4JMI' DR. City FL5Ae1?AyaLL6 state. VA ZIT) W39 office Pltonel dio^ q7�U esti (ns9 996 - 143�ex (5�W) 3 '`�7(oS� Umo11 R ClD c� /-�(ibl t5 APPLICANT INFORMATION Check any that apply; Chan a of ownershIp Chan a of use Change of name New busl.ness Buslnees Nsme/Type; u6uuA Hearn c(eb&T carjwr—JA 1u ' e4tc C4ywc. A Previous Business on this site NC NIG (tVL'W SUPT ) Describe the proposed business induding use, number of employees, number ofshltks, available parking spaces, number of U4L � FECf _ vsb lcles, and any additional Information that you can provide; Md; DCr5 A STTAFE C'tjRkM6 fZ�MrALI Pi.0 "This Clearance will only be valid on the parcel fbr which It Is approved, 7ryou ahange, Inronsll� or move thu usn to a now looetton, r, nowZouing Clcansnoe will be required, 1 hereby cert* that I own or have the owner's permission to use tic aptee lndlaaled on th(s applioatiou, I also certify thattlho lntbrmadon provided Is true and roaumts to the beat army koowladge. I have reed rho eandltions of approval, and I undetatend thein, and that I will abide by them. Signature Printed 'F -w* t S CouvIA4A!+P APPROVA INFORMATION Approved as proposed [ J Approved with conditions [ ] Denied [ J Daokflow pmventlon device and/or current test data needed for this site. Conteot ACSA, 977-4511, x117. [ ) No physloal site Inspoctlon has been done for this olearance. Thorofare, It Is note determinetlon of compllance with the existing site plan. [ J This site complies with the cite plan as of tbia dote, Notes, Building Official to Zoning Official Data Other Oftlelnl DAte County of Albemarle vapartment of uommunity uavaropmenx 401 McIntire Hood Chariattesville, VA 22902 Voice; (434)196-5832lr= (434) 972-4126 Revised 7/1/2011 Page 2 of m0vt VWh,� 2015 -May -01 03:10 PM Augusta Health Plant Ops 5403324769 Intake to complete the following; Reviewer to complete ttho following: Y /ial, Square fbolage of Use; 11-70 Is u9'''((n LI, M or PD1P xaning? Ifao, give applioent it Certified Eng'ineer's Report (0311) packet. 61 N • Y/O Permitted as: Al i (JA &V*'. Gni Wlll there be ibod preparatlon? Under Scotion: 2 i{,'2 - If so, give applicant a Reollh Department fbrrn. Zoning review can not begin untll we recelve approval *om Health Supplementary regulations seodon: Dcpt, VAX DATE Clrole the one that oppllea Is pnreel on private well pu Ile wR If private well, provide Hea e e mons form. Zoning review can not begin until we receive approval Rota Health Dept, PAX DATE Circle the one thgt ap I e Is parcel on neptl r ttbllc sews YIN Will you be putting up a new sign of any kind? Sign permit, Permit # If so, obtain proper CYJ/ M Will there be any new construction or ronovdtlons? If so, obtain the proper Permit, Permit# -LW41 %'7? { ill'—' Zoning to complete the following: Parking fbrmula: 1-6 e-) N Required epacas. Y / (N ms Iteo bt2 verified in the field; Inspector Noted Date. 3/6 YlclRltt ns: Y/ Ifao, Ist; Pt'ofkai lQq >;" If so, i�t''st: srinnret /N If no, hist; '\ O SP's: ` IN eo, Fiat: 9Q/ Clearances: SDP's rJ sr- J 67-4 Revised 7/1/2011 Page 3 of 3 2015 -May -01 03:10 PM Augusta Health Plant Ops 5403324769 4/6 lKxJ,S(Fj M --min CRozfir coluvamco yv- CFW r~Lcwcr- QnN 2015 -May -01 03:10 PM Augusta Health Plant Ops 5403324769 I, . ; •''. 1 •.I 'SN1 ' W.)xuN:$av NaIND DUOS 99M 9OZg NWoonlxmj 1 aooMly ` 5/6 H1."PYUh Y-.6n9,l!' ^I z 1no,ilY'1 2015 -May -01 03:10 PM Augusta Health Plant Ops 5403324769 CERTMCA,TZON THAT NOTICE OF TSE APPLICATION W BEEN PROVIDED TO THE LANDOWNER Tlils form must accompany toning applications (Home Occupation, Zoning Clearance, Zoaiing Adntlnlsfrncor Delermlaatlons or Appeals, Sign Perrnlfs,13u11d1ng Parnrlfs) if the appllcatson Isnot the Mner. 1 certify that notice of the application, /` plIM Bnei Z -OM 6 r -L M(e,- [County application name and number] was provided to Ke''TtLW 0- gTRL CMIN61 the owner of record of Tax Map [name(s) of the record owners of the parcel] and Parcel NUlnber 05400-00-00-11000 by delivering a copy of the application In Elie manner Idendfled below: Hand delivering a copy of the applicatlon to [Natne of the record owndr 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] M61 Date . . Melling a copy of the applioation to W��516N� a' Sj*gLLLN% S [Name of the record owndr if the record owner Is a person; If the owner of record is an entity, identify the recipient ofthd record and the recipient's title or office for that entity] on 05101/ zoos— to the following address. Date ?n t3QX 6247 C64A6fLOME'51Rx C VA ,90.9a [address; written notice malled to the owner at the last known address of the owner as shown on the current roal estate tax assessment books or current real estate tax assessment records satisfies Ibis requlresnent]. 1. Signdture of Applicant 6/6 ��'� �-� �d�,•1. Dir v�- Print Applicant Name r ,� 1narA V:h e.b 151 /U1 r Date I /