HomeMy WebLinkAboutCLE201500145 Application 2015-07-23Application for Zoning Clearance
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PLEASE REVIEW ALL 3 SHEETS
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Clieck # Date: -
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: 061 WO-01-OA-009AO Existing Zoning C-1
Parcel Owner: Sue A. Albrecht
Parcel Address: 2300 Commonwealth Dr. City Charlottesville State VA Zip 22901
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? Sue A. Albrecht
Address : 255 Ipswich Place City Charlottesville State VA Zip 22901
Office Phone: (434) 531-2436 Cell# 434-531-2436 Fax# 434-973-0732 E-mail sue@designenvirons.com
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name X New business
Business Name/Type: Dot to Dot Pediatric Speech Language Therapy LLC
Previous Business on this site Blue Ridge Internet
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:
Speech therapy, 1 Employee, 1 Shift - 48 available parking spaces and no company vehicles
*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 to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed
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 1 % j
%
Zoning Official 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 USQLl, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y
Wil ere be food preparation?
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from IIealth
Dept. FAX DATE
Circle the one that applies
Is parcel on private well olic Ovate
If private well, provide He epartment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic or sewe ?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/
Wil er ny new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Reviewer to complete three following:
Square footage of Use: 7`-�
/ N nn
Permitted as: KA O�tic.e
Under Section: 7-2- ° Z - /
Supplementary regulations section:
Parking formula:
Required spaces:
Y /
Items to be verified in the field:
Inspector : Date:
Notes:
Violat•ons:
Y / Tj1_
If so, ist:
Proff s:
Y /�
If so, List:
Variance:
(6/N
If so, List:
SP's:
Y/iq)
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, Sue A. Albrecht
[County application name and number]
was provided to Sue A. Albrecht
[name(s) of the record owners of the parcel]
and Parcel Number 061 WO -01 -OA -009A0
manner identified below:
the owner of record of Tax Map
by delivering a copy of the application in the
X Hand delivering a copy of the application to Commonwealth Business Center, 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 07/02/2015
Date
Mailing 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
to the following address:
[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]. _
151gnatuiVof Applicant
Sue A. Albrecht
Print Applicant Name
07/02/2015
Date
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