HomeMy WebLinkAboutCLE201400130 Application 2015-06-23Application for Zoning.leara cc
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PLEASE REVIEW ALL 3 SHEETS Check # Date:_
Receipt: # Staff:
PARCEL INFORMATION
Tax Map and Parcel: 32-1Ba2 Existing Zoning LI
Parcel Owner: universal Test Equipment, Inc.
Parcel Address: 1625 Quail Run Road City Charlottesville State VA Zip 22911
(include suite or floor).
PRIMARY CONTACT
Who should we call/write concerning this project? David Huynh
Address : 1625 Quail Run Road City Charlottesville State VA Zip 22911
Office .Phone:4{ 3-0 ) 873-4545 ext. 13 Cell 9 434-82MO73 Fax # 431-973-4550 E-mail dahuynh@uteinc.com
APPLICANT INFORMATION
Check any that apply: Change of ownership Change,of use Change of name._ New business
Business Name/Type:.dgems RecoverCare - Durable Medical Equipment Rental
Previous Business on this site
Describe the proposed business including use, number of employees, number ofshifts, available parking'spaces, number of
vehicles; and any additional. information that you can provide: 6 ompfoyees, 3sbifts,10yehicles.
Space will be used as a warehouse for deliveries of durablecma&cal equipment to nearby ho5pitaiiactlitles, _
*This Clearance will only be valid on the pareel'for which it is approved:. Ifyou change, intensify or:move the,tisL,ta a new location, a new.Lnnn g
Clearance X+ill be required.
Ihereby certify that.1 own or have the owners permission to use the space indicated on this application. ,I also certify that thee infomiadon provided
is true and accurate to the best, of 1 , knowledge. t have read the conditions of approval, -anal Lunderstand them, and that,]. �k}ail abide:by them.
Signature Printed t✓ Uzi
ROVAL IN.FORMATIONN
V1 Approved as proposed [ ] Approved `:•7th conditions [ ]:Denied
[ ] Backflow prevention device and/or current test data needed. for this site: Conta'ot AC'SA, 977-45.1.1., .x.1:17.
[ ]'No physical site. inspection has been done for this. clearance. Therefore; itis nota determination of compliance with the existing
site pian,
[ ] This site,complies with the site plan as of this date.
Notes:
Building +t7f Official Date (0 3 t y
Zoning Lod
Official 4 Date
Other Official � J' Date
County of Albemarle Department of Community Development
401 He tlltire ,Road Charlottesville, VA 22902 Voice: (434) 296=5832 Fax; (434) 97Z-4126
Revised.?/1/201 t Pap 2 of3
Intake to complete the following -
2)/ N CEY WMIf-t1 �Thahq
Is use ina HI or PD1P zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Yl
Will ere be food preparation?
If so, give applicant a Health Departmentform.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on private well o public water?
If private well., provide Healt ep ment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that a=sewer?
lie
Is parcel on septic o
Y,/N
Will you be putting up -a new sign of any kinO Ifso, obtain proper*.
Sign permit.
Q
Permit#
(D/ N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit # 2 0 5.� 3 C i
to
Y
If
Reviewer to complete the following:
Square footage of Use:���
Y / pitted as: SfWactioulmol—sliu
Under Section:
Supplementary regulations section:
,Yarling formula:
Required 'spaces' C
Y/
IteW be verified in ,the field:,
Iirspector
Notes:
Y
If
SP'
Ifs Nast;
JLY'S p^7y
.Rev -sed 9l1/26I1 Page3of3