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HomeMy WebLinkAboutCLE201700095 Application 2017-04-24Application for Zoning.Clearance 7 ©�' s`' (0— CLE # Ta/ PLEASE REVIEW ALL 3 SHEETS OFFICE USE ONLY Check # Jz� Date: 2 Receipt # / / Staff: PARCEL INFORMATION Tax Map and Parcel: 032000000005BO Existing Zoning Light industrial Parcel Owner: Seminole North, LLC Parcel Address: 4257 Seminole Trail City Charlottesville State VA Zip 22911 (include suite or floor) PRIMARY CONTACT Who should we call/write concerning this project? Tim Slagle Address :1180 Seminole Trail, Suite 105 City Charlottesville State VA Zip 22901 Office Phone: 4( 34) 973-5571 Cell # (434) 953-6735 Fax # (434) 973-5580 E-mail trslagle@embargmail.com APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name X New business Business Name/Type: Roberts Home Medical Previous Business on this site Badger Fire Protection 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: Office space with small showroom and storage of wheelchairs and other assistive devices; 7 employees; 1 shift; 40 available parkinq spaces; 9 vehicles including company vehicles *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 have the owner's permission to use the space indicated on this application. I also certify that the information provided is true and accurate to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them. Signature Printed 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, 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 Date 1:4h/ Zoning Official z-&u72_ Date %�� 2 z / 7 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: / N s use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. YWill e/ ZiS re 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 ublic wat If private well, provide 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 septic oplifiblic sewer? Reviewer to complete the following: Square footage of Use: h (Y)/N Permitted as: Under Section: Supplementary regulations section: Parking formula: ! Required spaces: Y/ Items to be verified in the field: Y)/N Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. � L Permit # ���' "vim Inspector : Date: C",D/A-- p crl "Ai G� ®/N Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # Zoning to complete the following: Notes: Violations: Y/N If so, List: Proff rs: Y/W If so, List: Variance: Y/N If so, List: SP's: Y/N If so, List: Clearances: SDP's Revised 11/1/2015 Page 3 of 3 April 20, 2017 Page 2 Electrical Interference: RHM's operation does not have any equipment that generate any electrical disburbances. Sincerely, Tim Slagle For Seminole North, LLC