HomeMy WebLinkAboutCLE201600096 Application 2016-05-26Application for Zoning Clearance A'�'
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OFFICEVSE bNICY
PLEASE REVIEW ALL 3 SHEETS Check # ?(0 Date:
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel:. to 01 Existing Zoning ld f
Parcel Owner:
Parcel Address: 1450 Sachem Place Ste 101 City CHARLOTTESVILLE State VA Zip 22901
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? LINDSAY ROSENBLUM
Address :1950 OLD GALLOWS RD STE 520 City VIENNA State VA Zip 22182
Office Phone: (703) 847-8899 Cell # Fax # E-mail LROSENBLUM@MYEYEDR.CC
APPLICANT INFORMATION
Check any that apply: x Change of ownership Change of use Change of name New business
Business Name/Type: MYEYEDR OPTOMETRY OF VIRGINIA, LLC-Charlottesville Sachem
Previous Business on this site Dm- Record & Record
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:
OPTOMETRY, 13 EMPLOYEES
*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 certif t I own or have o er' ermission to use the space indicated on this application. I also certify that the information provided
is true and curate o the best of 1 have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed Jay Lunsford -
APPROVAL FO ATION
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 p1an.
[ ] This site complies with the site plan as of this date.
Notes
Building Official Date _ �4 �J_L if C G
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/l/2011 Page 2 of 3
Intake to complete the following:
Y I ,
Is us n LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/
Will t ere 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 o pub ' ter?
If private well, provide HeaVAJ2qlawfient form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that appl'
Is parcel on septic or ublic sewe .
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
YIN
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: '� � DO
Y/N
Permitted as: 4 1S. ;4 0' �cc
Under Section: 7—Z 2 - 11
Supplementary regulations section:
Parking formula:
Required spaces:
Y/N
Items to be verified in the field:
Inspector• -
Notes:
Violations:
Y/
If so, tst:
Proffers:
Y/0
If so, List:
Varia ce:
Y /
If so, ist:
SP's:
Y I
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,
was provided to
[County application name and number]
[name(s) of the record owners of the parcel]
and Parcel Number
manner identified below:
Hand delivering a copy of the application to
the owner of record of Tax Map
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
Mailing a copy of the application to 600PJP390, 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 3/11/2016
Date
1700 LAMBS RD CHARLOTTESVI
to the following address:
VA 22901
[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].
1:�)o 7x
Sig&e k Applicant
JAYLUNSFORD
Print Applicant Name
3/11 /2016
Date