HomeMy WebLinkAboutCLE201700097 Application 2017-04-19Application for Zoning Clearance
CLE #
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY LI
Check # / ���i5` Date:
Receipt # Staff -
PARCEL INFORMATION
Tax Map and Parcel: 06100000012300 Existing Zoning Planned Develp. Shop. Center
Parcel Owner: Rio Associates Limited Partnership
Parcel Address: 406 Albemarle Square City Charlottesville State VA Zip 22901
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? Thomas A Eagleson
Address: 1825 Avon St Ext City Charlottesville State VA Zip 22902
Office Phone: (434) 234-3945 Cell # Fax # 434-922-2300 E-mail TomE@SeraphicGroup.com
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name X New business
Business Name/Type: Wave Clinic, LLC / Therapy
Previous Business on this site Wellness, MD, LLC
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:
Therapy services 2 orpploy es open parkipg as sit@ is- Ie6ated In a Shopping area
*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 9wn or have the owner's p mission to use the space indicated on this application. I also certify that the information provided
is true and accurate the best of my knowle . I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed Jeffrey Brand
APPROVAL INFORMATION
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 plan.
[ ] This site complies with the site plan as of this date.
Notes:
Building Official Date
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 11/02/2015 Page 2 of 3
Intake to complete the following:
Is /
Is US& LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/
Will here 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 He ment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic or blic sew ?
Y/N
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:
Square footage of Use: Z �/y S
C/N Permitted as: Mom, , (A/ fyfjC ei
Under Section: ZS • 'L • 1
Supplementary regulations section:
Parking formula: yr
e y�
i
Required spaces:
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
Viola ions:
Y /k
If so, List:
Proff
Y /0:
If so, List:
�ariance:
/N
If so, List:
�/s N
If so; List:
7 —7— Z 9
Clearances:
SDP's
2vI2— �L7
Revised 11/1/2015 Page 3 of 3
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