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HomeMy WebLinkAboutCLE201600189 Application 2016-08-26Application for Zoning Clearance ` CLE#o?DJLQ - OFFICE USE ONLY g iq PLEASE REVIEW ALL 3 SHEETS Check # Date: Receipt # Staff: PARCEL LN'FORAUTION Tag Map and .Parcel: 07800-00-00-031CO Existing Zoning Planned Deep Mixed Comm'I Parcel Owner: PJP BUILDING ONE L C Parcel Address: 675 PETER JEFF. PKWAY, STE_ 130 City CHARLOTTESVILLEState VA Zip 22911 (include suite or floor) PRIMARY CONTACT Who should we call/write concerning this project? EVELYN FRAZIER, MD Address: 707 GRAVES ST City CHARLOTTESVILLE state VA Zip 22902 Office Phone: ( Cell # Fax # E-mail APPLICANT LNMPUNIATTON PATHWAYS DEVELOPMENTAL PEDIATRICS PLLC Check any that apply: Change of ownership Change of use Change of name X New business BusinessName/Type: PEDIATRIC MEDICAL PRACTICE. Previous Business on this site MEDICAL PRACTICE Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of vehicles, and any additional information that von can provide: `This Clearance will only be valid on the parcel for which it is moved If you change, intcns* or move the usa to a new location, a new Zoning Clearance will be requiurd. I hereby certify that I own or have the ounces pamission to use Flee space indicated on this application. I also certify that the information provided is tnw and the best my knowledge, have lice conditions of approval, and I understand them and that I will abide by them a ted EVELYN FRAZIER, MD AP"PRO FORMATION _.. Approved as proposed [ } Appraved with conditions [ ] Denied ] Backflow pret=tion deice 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. [ ] Thais site complies with the site plan as of this date. Notes: Bundieg Offrcial Date Zoning OBiieial Date. Other Of$cial Date County of Albemarle Department of C:ommurnty Developtment 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5932 Fax: (434) 9724126 Revised 1110212015 Page 2 of 3 Intake to complete the following: YIN Is use in LL HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. YIN Will there be food preparation? If so, give applicant a Health Department fcmn. Zoning review can not begin untilwe receive approval from Health Dept. FAX DATE Circle the cue that applies Is parcel on private well ptr ter9 If private well, provide H I3e t fnrm Zoning m iew can not begin until we receive approval from Health Dept. FAX DATE _ Circle the one that pliesll Is parcel on septic ptie or li�c sewe�,�.° YIN Will you be putting up a new sign of any (rind? Sign perurit. Permit # Reviewer to complete the following: Square footage ofUse:' ./ YIN Permitted as: A I o Under Section: Z A 2 Supplementary regulations section: Parking formula: // Required spaces: Yf Items to be verified in the field: 1f so_ obtain proper Inspector: Date: Y f N h©tes: Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # Zoning to com fete the following: Violations: Y f fJ If so, Proffers. & f N Ifso, List: Z r►a,g 6 % — Marl ce: YI T If so, List: S>''s• YI If so, List: G7earart es: SDP's Revised 11/1/2015 Page 3 of 3 CERTIFICATION THAT NOTICE OF THE APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER This foray must accompany zoning applications (Home occupation, Zoning Clearance, Zoning Admimstrator Determinations or Appeals, Sign Perimis, Bu%Iding Pere:its) if the application is not the of aff. I certify that notice of the application, ZONING CLEARANCE [County application name and number] was provided to PJP BUILDING ONE L C [name(s) of the record owners of the parcel] and Parcel NI umber 07800-00-00-031 CO 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 0 Nfailing a copy of the application to SHARI SHEARS, PRINCIPAL [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 AUGUST 10, 2016 to the following address: Date 300 ARBORETUM PLACE SUITE 330, RICHMOND VA, 23236 [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 cant real estate tax assessment records satisfies this requirement]. 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