HomeMy WebLinkAboutCLE201700094 Application 2017-04-24Application for Zoni g Clearance
C` CLE # O - 1
��RCIN�P
OFFICE
PLEASE REVIEW ALL 3 SHEETS
Check # -� Date:'V' �L ("
Receipt # i f C % Staff:
PARCEL INFORMATION
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Tax Map and Parcel: (0� ( 7`V U' `� V V G Existing Zo
n
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ParcelOwner: l�1
Parcel Addressd to? .!' �V StateVA - Zip��Ifl
(include suite or floor)
PRIMARY CONTACT
Who
should we call/write conce�rningr this project.
Address : 61 City 5f,"IVAQ, State v
Office Phone: ''Q # ivO-Z Fax # E-mail(N4 l
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APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type:
Previous Business on this site —
Describe the proposed business including use, number of employees numbe7f shifts vailable par ' spa es, be of
vehicles a d a additional i rmation that yo an ovide:
*This Clearance will onl al on the pa 1 for hich it is ap ov . If you change, intensify or move the use to a new location, anew 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 a orate to the best my nbwledge. I have rea a co itions of approval, and�11,unders nd them, and that I will abide by them.
t`�
Signature inted
APPROVAL INFORMATION
Approved as proposed [ ] Approved with conditions ( ] Denied
Bacldlow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, xi 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
I
Zoning Official { Date
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 2%-5832 Fax: (434) 972-4126
Revised 11/02/2015 Page 2 of 3
1M
Intake to complete the following:
Y/
Is use LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /nN
Wi&Kere 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 Parking formula:
Is parcel on private well or lien-war?If private well, provide Heal nt form.
Zoning review can not begin until we receive approval from Health Required spaces:
Dept. FAX DATE S
Circle the one that appli
Is parcel on septic or 6e wer.
Y/N
Will you be putting up a new sign of any kind?
Sign permit.
Permit #
Reviewer to complete the following:
Square footage of Use: tS d U
/ N �
Permitted as:
Under Section: ,&2
Supplementary regulations section:
Y /
Items to be verified in the field:
If so, obtain proper
Inspector Date:
Y / N Notes:
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Violations:
Y iiy
If so, List:
ffers:
�O/N
If so, List:
V ance:
If
If so, ist
SP's
If/�)
If so, List
Clearances:
SDP's ZUj2_Z�
20
Revised 11/1/2015 Page 3 of 3
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2711,"
Physical Therapy
Front Elevat,,on Nrn-1,1 jnii �natecigr,
AVERY900, CAST VINYL DECORATION
1 '8 , DIBOND
,4UNPERSIZED ALUMALITE BACKER
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27866
COUNTY OF ALBEMARLE
2017 BUSINESS LICENSE
State law reference — Virginia Code §58.1-3700. et seq.
BL ACCT # : 279729 - 903427
Licensee: DARCY J RIGGINGS, PT PLLC
61 FARMVIEW RD
STANARDSVILLE VA 22973-0000
BEGINNING DATE: April 03, 2017
Trading As: DARCY J RIGGINGS, PT PLLC
UNKNOWN LOCATION
CHARLOTTESVILLE VA 22902-0000
vi-N--WA Y111-ILt
EXPIRATION DATE: December 31, 2017
The Licensee is hereby properly registered, licensed and authorized to engage in the following activity,
exclusive to all other:
713940.00 Fitness i£ Recreational Sports Centers
Zeh `
Notice: This license will expire at mi ight on the Expu at on Date indicated above. Continuing to engage in any business
activity after the expiration indicates your intent to renew this license and will therefore obligate the Licensee to renew
pursuant to Chapter 12, Article 1 of the Albemarle County Code.
Signed: Lam .9--- 03/16/2017
COUNTY OF�LBEMARLE REPRESENTATIVE DATE