HomeMy WebLinkAboutCLE201600225 Application 2016-10-05Application for Zoning Clearance
CLE # &'W& - a'?ad 5
OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: 07800-00-00-01504 Existing 7oning HC
Parcel Owner: Albemarle Land LLC
Parcel Address:198 Spotnap Road Suite C-2 City Charlottesville State VA Zip 22911
(include suite or floor)
PRIMARY CONTACT
R?ln should we call/write concerning this pr(kiect? Donnef B. Eddy c/o Jonathan M. Eddy
Address : 1522 North Main Street City Davenport State IA Zip 52803
Office Phone: C_) Cell # Fax # E-mail deddydc@yatwo.com _—
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name X New business
Business Name/Type: Eddy Family Chiropractic
Previous Business on this site Virginia Prosthetics
r Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicles, and any additional informatton that you can provide:
Chiropractic office. Two Chiropractors, one office manager. Office hours: Monde - Friday 9.00 AM - 6:00 PM Saturday
by appointment. Ample parkino.
*This Oi:arance 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.
l hereby ernify that I own or have the --ors permission to ape the space indicated on this application. l also certify that the information provided
is true and accurate to the best of my knowledge. I have read the onditions of approval, and I understand them, and that I will abide by theta.
Signature R - ZV� Printed Donnel B. Eddy
PPROVAL INFORMATION
i Approved w proposed [ ] Approved with conditions [ ] Denied
! [ Backflow prevention device and/or current test data needed for this site. Contact AUSA, 977-4311, x117.
[ ] No physical site inspection has been done for this clearance_ Therefore, it is not a determination of compliance with the exibting
site plan,
[ I Phis site complies with the site plan as of this date.
;dotes:
Building Official Date f � I `{ I L fa
Zoning O �aI Date ,/'jA�2
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 : 11021201 5 Page 2 of 3
intake to complete the following:
Reviewer to complete the following.,
Y N
f 5quare footage of Use: I
is use in Ll, Ill or Pl)IP zoning'? if so, give applicant a Certified
Engineer's Report (CSR) packet.
; N
OermittcdAll
as:
[�Y
Under Section: •2
t Will ere be food preparation?
�
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from Health
i Supplementary regulations section:
Dept. FAX DATE
Circle the one that applies
Parking formula:
Is parcel on private well o blie orate
If private well, provide 1 leap artment form.
Zoning review can not begin until we receive approval from Health
Required spaces:
Dept. FAX DATE
a
1Y�
Circle the one that applies
Items to be verified in the field:
i Is parcel on septic a ub c sew-e
�YJN
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #,� �_
I Inspector : Date:
Y in
dotes:
Will ere be any new construction or renovations?
!
i
i If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Violations:
3Y;
If sbst:
Pro s:
Y/
If so, List:
i
Vari ce:
Y l
If so, rat:
Y 1
Ifs , ist:
Clearances:
SDP's
Revised 1 II1/2015 Page 3 of
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, Zoning Clearance
[County application name and number]
was provided to _ Albermarle Land LLC _ the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number _ 78 - 15C4
manner identified below:
0 Hand 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
L Mailing a copy of the application to Albemarle Land LLC Stephen M. Melton, Realtor
[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 06/2212016
Date
to the following address:
_ _PO Box 8147 195 Riverbend Drive 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].
Signature of Applicant
Donnel B. Eddy
Print Applicant flame
08/22/2016
Date
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