HomeMy WebLinkAboutCLE201500144 Application 2015-07-22Application for Zoning Clearance
CLE # a o 15 -- 144
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # X30, ( Date: -7—f'3— ( 5
Receipt # 1 Vo 5--7,S— Staff: 1+t!
PARCEL INFORMATION
Tax Map and Parcel: (-a 1 —'3.-1z Existing Zoning (a w+ e �_Irc i c�t
Parcel Owner: Todd Carr DBA Carr Wood Products, LLC c/o Management Services Corp.
Parcel Address: 259 Hydraulic Ridge Rd. Ste. 203 City Charlottesville State VA Zip 22901
(include suite or floor)
PRIMARY CONTACT
Who should we can/write concerning this project? Charles Bradley Swisher, DDS
Address: 259 Hydraulic Ridge Rd. Ste. 203 City Charlottesville State VA Zip 22901
Office Phone: (A34) 973.1222 Cell # (434)566.9868 Fax # (434)973.2255 E-mail brad@swisherdentistry.com
APPLICANT INFORMATION
Check any that apply: X Change of ownership Change of use X Change of name X New business
Business Name/Type: Swisher Dental, PLLC/Dentist Office
Previous Business on this site R. Scott Knierim and Associates/Dentist Office
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:
General Dentist Office, 14 1 8-5 F 8-1),pus
employees, shift (M -Th and parking spaces available, 0 company
vehicles, the space has been a dental office for 30 plus years.
*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 accurate best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed Charles Bradley Swisher
APPROVAL INFORMATION
Approved as proposed [ ] Approved with conditions [ ] 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 11411
Zoning Official /Z✓ Date
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:
Is /
Is us LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/
Will re 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 or ►c w ter?
If private well, provide Healt artment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that appli
Is parcel on septic or lic se
Y/N
Will you be putting up a new sign of any kind?
Sign permit.
Permit #
If so, obtain proper
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: _3 7Z> ()
OIN
Permitted as:
Under Section:
Supplementary regulations section:
Parking formula:
NAVS
Required spaces:
Y/
Items to be verified in the field:
Inspector•
Notes:
Date:
Viol ions:
Y/(Y
If so, List:
Proffer
Y/
If so—,List:
Varia ce:
Y/
If so, ist:
SP'
Y/
If so, List:
Clearances:
SDP's
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, Albemarle Application for Zoning Clearance
[County application name and number]
was provided to Todd Carr DBA Carr Wood Products, LLC the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number
manner identified below:
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
X Mailing a copy of the application to Carr Wood Products, LLC
[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 07/06/2015
Date
to the following address:
c/o Management Services Corp. P.O. Box 5306 Charlottesville, VA 22905
[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].
ign tune of Applicant
Charles Bradley Swisher
Print Applicant Name
July 6, 2015
Date
.
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