HomeMy WebLinkAboutCLE201600031 Application 2016-02-16Application for Zoning Clearance
CLE # ;2011D- -at
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OFFICE USE ONLY
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PLEASE REVIEW ALL 3 SHEETS
Check # 1(o 49 Date:
Receipt # 10Z)5-1 _ _ Staff. LLazlll
PARCEL INFORMATION
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Tax Map and Parcel: Greenbrier Off Pk, Parcel 061 WO -01-00-00100) Existing Zoning office Building W
Parcel Owner: Cox Properties, LLC
Parcel Address: 1416 Greenbrier Place City Charlottesville State VA Zip 22901
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? Kathy Brown
Address : 1416 Greenrier Place City Charlottesville State VA Zip 22901
Office Phone: (434) 979-4516 Cell # Fax #.434-220-1010 E-mail kathy@virginiapregnancy.org
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name x New business
Business Name/Type: The Pregnancy Centers of Central Virginia
Previous Business on this site Zonin IDSA Inc
Describe the proposed business including use, number of employees, number of shifts, available parking,_spaces, number o
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vehicles, and any additional information that you can provide: b*la NOOed WN Aldo 719 ��i/y
Non-profit arg, 9 employees,! shift, 1-5 volunteers/day, 24 park9 spaGars plus averflow of I Q -2d-d-'t spaces,9-14 cars -
*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 th best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature ANPrinted Kathy Brown
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 C.
Zoning Official Date �' b
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 11/02/2015 Page 2 of 3
Intake to complete the following:
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
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Will there 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 orfu is w r?
If private well, provide Heallb ent 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 c 7
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Will you be putting up a new sign of any kind?
Sign permit.
Permit #
If so, obtain proper j
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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: 0 t)L) _
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Permitted as: /Lt L,
Under Section:
Supplementary regulations section:
Parking formula:
7-,.s J Aa
Required spaces:
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Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
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If sovist.
Proff
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If so, List:
IN
Varia e:
Y 1
If so, sl
SP's:
Y I
If so, ist:
Clearances:
SDP's
Revised 11/1/2015 Page 3 of 3
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