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Home My WebLink AboutCLE201500148 Application 2015-08-06Application for Zoning Clearance � � 1rrriN�r� PLEASE REVIEW ALL 3SHEETS OFFICE USE ONLY Check# C_ea 5y\ Date: Receipt# VL90-10 1 Staff: A,5fZ— PARCEL INFORMATION Tax Map and Parcel: ID: 061M0-00-12-0001135 Existing ZoningPlanned Development Mixed Cc Parcel Owner:Maine, John D. or Demmie C. CO RISI Inc. Parcel Address:630 Berkmar Circle City Charlottesville State VA Zip 22901 (include suite or floor) PRIMARY CONTACT Who should we call/write concerning this project? Lynne Crotts Address :724 Elliott Ave City Charlottesville State VA Zip 22902 Office Phone: ( ) Cell #434-825-4934 Fax # E-mail [crotts@hotmail.com APPLICANT INFORMATION Check any that apply: Change of ownership X Change of use X Change of name X New business Business Name/Type: Orion Academy/Private School Previous Business on this siteWahoo Tutors 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: private school; 3 employees; 3 shifts; 2 parking spaces; 2 vehicles; number of students: 15-20. *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 PrintedLynne Crofts AROYAL INFORMATION IPA pproved 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 s'te complies wit the site p ap as oft•ris date. N otes: Building Official Date Zoning Official Date D ps Other Official Date County of Albemarle Department of u0mmunify ueveiopmem 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: Reviewer to complete the following: Y /li:/Square footage of Use: Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Perrniffed as: 61., 1 Will�ere be food preparation? Under Section: (� i' I If so, give applicant a Health Department form. Zoning review can not begin until we receive approval from Health Supplementary regulations section: Dept. FAX DATE ��j Circle the one that applies Park 1' fon -Q,, 1 Is parcel on private well o► ;blc Ovate I ry% If private well, provide Hea1 Intl lthpartment form. Zoning review can not begin until we receive approval from Health Required spaces: Dept. FAX DATE Y/ Circle the one that ap ' ✓ ' r ' Is parcel on septicr public sewer? Y/N Will you be putting up a new sign of any kind? If so, obtain proper Sign perm 't. Permit# Y/N Will there be a iy new construction or renovations? If so, obtain th( proper Permit. Permit# 7nninn to r.mmnlete the Mllnwina' --.....� ----...----- --- viol • ns: YIN If so, ist: Proffers: Y/(`) If so, ist: vari rri�ce: Y/�1) If so, est: SP's• 1'/ If so, est: Clearances: AO ,qC/ MW 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, [County application name and number] was provided to Maine, John or Demmie C. CO RISI Inc. the owner of record of Tax Map [name(s) of the record owners of the parcel] and Parcel Number ID: 061 MO -00-12-0001 B5 manner identified below: by delivering a copy of the application in the X Hand delivering a copy of the application to Maine, John or Demmie C. CO RISI Inc. [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] • ', 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] Oil 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]. SignVire- of Applicant Lynne Crotts Print Applicant Name July 20, 2015 Date �--AH00 TUTORS, Emergency Evacuation Plan Directions: Complete and post this form by every telephone in the Center. Section 1 lists local emergency phone numbers. Section 2 presents a floor plan of the Center, indicating the location of emergency exit signs and the evacuation destination unless it is inaccessible. In that case, use the secondary evacuation destination. Section 1: Emergency Phone Numbers Emergency: 911 Fire: 91 x Police: 911 Hospital: 911 Section 2: Evacuation Route J LL Z W 1 OFFICE w �` G X-7 K-3 Eta ROOM N7 (G x rS CLASSROOM AREA z_ «- Zax= � ewe El [�TEA r!��r,% Section 3: Evacuation Destinations PRIMARY: pq-v'kLat SECONDARY: -lZear pa'n� Lam' to - 11 1 i �2S ��vIS cloy Reii l9uW. ll4Sjruvr� m A i 41 G C�aSS d 0L)M a s s s EwY OFF, -Tb�a, 5 t, R, " Z I Z D F- z