HomeMy WebLinkAboutCLE201600167 Application 2016-07-25Application for Zoning Clearance
CLE # ")_a t!o ( 6 —1
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PLEASE REVIEW ALL 3 SHEETS
OFFICE U ON Y
Check # Date:
Receipt # 4C5 Staff:
PARCEL INFORMATION
Tax Map and Parcel: 61 W-3-06A1 Existing Zoning C-1
Parcel Owner: Hurt Investment Company
Parcel Address: 335 Greenbrier Dr. Suite 204 City Charlottesville State VA Zip 22901
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? Mohammed Almzayyen, DDS
Address: 335 Greenbrier Dr. Suite 204 City Charlottesville state VA Zip 22901
Office Phone: (434) 296-5250 Cell # 540-479-0344 Fax # E-mail Almzayyenm@gmail.com
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name X New business
Business Name/Type: Mohammed Almzayyen,DDS, PLLC , DBA: Blue Ridge Family Dentistry
Previous Business on this site Blue Ridge Family Dentistry, PC
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:
.r1ORW f' iRk: ho- i iro 11 a to 5. 6 employee-,
-T
*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 wn or have a owner's perm' use the space indicated on this application. I also certify that the information provided
is true and accurate the best of y o 1 ad the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed Mohammed Almzayyen, DDS
APPROVAL INFOAMATION
Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-451 I , 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 4 r
Zoning Official XA19 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 11/02/2015 Page 2 of 3
Intake to complete the following:
IsI(NJ
Is us m LI, 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 Health
Dept. FAX DATE
Circle the one that applies
Is parcel on private well o public water
If private well, provide Hea ep form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that a
Is parcel on septic of public sewer?
YIN
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y
Will ere 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: A �L _ S ; r .
/N �In'
ermitted as:
Under Section: 7-2, 2 .
Supplementary regulations section:
Parking formula:
a.�
Required spaces: �I
YI A
ItemsNdbe verified in the field:
Inspector • Date:
Notes: —
Violat ns:
Y/W
If so, List:
Prof s:
Y/
If so"fist:
Varia ce:
lY/(W
If so, List:
SP's:
Y/Q)
If so, List:
Clearances:
SDP's
Revised 11/1/2015 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.
1 certify that notice of the application, Zoning Clearance
[County application name and number]
was provided to Charles W. HurV Hurt Investment Company the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number 61 W-3-06A1
manner identified below:
QHand delivering a copy of the application to
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 Charles W. Hurt 1 Hurt Investment Co.
[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 07-18-2016
Date
to the following address:
195 Riverbend Dr. PO.Box 8147, Charlottesville, VA 22906
[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].
Print Applicant Name
07-22-2016
Date
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