HomeMy WebLinkAboutCLE201600097 Application 2016-05-26Application for Zoning Clearance-;"
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I ' IS
OFFICE USE WLY
PLEASE REVIEW ALL 3 SHEETS Check # OK9 Date:
Receipt # Staff:
PARCEL INFORMATION n `
Tax Map and Parcel: zz F` Existing Zoning Ua&wd �
Parcel Owner:
Parcel Address:600 PETER JEFFERSON PKWY,}city CHARLOTTESVILLE State VA
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? LINDSAY ROSENBLUM
Address: 1950 OLD GALLOWS RD STE 520
Office Phone: (703) 847-8899 Cell #
City VIENNA
State VA
Zip 22911
Zip 22182
Fax# E-mail LROSENBLUM MYEYEDR.CC
I APPLICANT INFORMATION I
I Check any that apply: x Change of ownership Change of use Chance of name New business
Business Name/Type: MYEYEDR OPTOMETRY OF VIRGINIA, LI_C-CHARLOTTESVILLE PANTOPS
Previous Business on this site DRS. RECORD AND 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, 8 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 certify that I own or hav e o er's permission to use the space indicated on this application. I also certify that the information provided
is true and accur4*4Gt the best m o ledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature
JAYLUNSFORD
APPROVAL UFORMATION
)'] Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, xl 17.
[ ] 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
Zoning Official � ^f
Other Official
Date
Date
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:
Y l
Is u4e4n LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Yl�tere
Will 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 pub[' ater?
If private well, provide He artment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that app ' p
Is parcel on septic or p lic se r?
YIN
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
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: 16 Square footage of Use: _ _ 1 O
JO/ N n1} ey
Permitted as: �ylcz�i�c� l r;ca
Under Section:
Supplementary regulations section:
Parking formula:
vas
Required spaces:
YI
Items to be verified in the field:
Inspector • Date:
Notes:
Viol �tdons:
I
If sost:
Proffers:Y
"ffstf)N
so, List:
Vari ce:
Y/
If so, List:
SP's:
Y/N
If so"Itist.,
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:
the owner of record of Tax Map
by delivering a copy of the application in the
Hand delivering 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
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
to the following address:
1700 LAMBS RD CHARLOTTESVILLE, 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].
Si atur of 2p&plicant
JAY LUNSFORD
Print Applicant Name
3/11/2016
Date