HomeMy WebLinkAboutCLE201700132 Application 2017-06-01 (2)Application for Zoning Clearance
CLE # 121
OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS
Check # � Date: -
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: 06100-00-00-027A1 Existing Zoning CO
Parcel Owner: Young Property Investments, LLC Mark C. Young, President
Parcel Address: 240 Hydraulic Ridge Road, Suite 101 City Charlottesville State Virginia Zip 22901
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? Mark C. Young
Address : 2599 Earlysville Road City Earlysville State Virginia Zip 22936
Office Phone: (434) 979-1365 Cell # 434-242-3157 Fax # 434-979-7880 E-mail marknkimyoung@hotmail.com
APPLICANT INFORMATION
Check any that apply: X Change of ownership X Change of use X Change of name X New business
Business Name/Type: Mark C. Young, DDS
Previous Business on this site PSB Testing, 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:
Dental Prac-tice, 7 Employees, 1 Shift, 75 Parkipg SpaGes, 7ernployee vehiGles, a
patient 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 Mark C. Young
APPROVAL INFOR
,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�/ 7
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:
Y/h
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y /
Wi ere 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 wel r pu ' ater?
If private well, provide ealt artment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies --_-
Is parcel on septic public sew
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
0 / N
Will there be any new construction or renovations?
If so, obtain the prope�P rmit.
J Permit # 2� �' --6
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: /f b�
&/ N a�� Permitted as: i
Under Section: 7-3 ,1 •�
Supplementary regulations section:
Parking formula:
N
Required spaces:
Y /
Items to be verified in the field:
Inspector : Date:
Notes:
Viola ons:
Y /li
If so, List:
Proffers:
Y /
If so, ist:
Varia c
Y/
If so, List:
SP's:
Y/
If so, ist:
Clearances:
SDP's
Revised 11/1/2015 Page 3 of 3
car cox v WHIM
c�c
° G° O°°
60 O O O O
o
oil
D II.NOo it II
� I I
r
Z
a
I I
I�
°
- iillll n?A�iO
�A N u9 �A -IMPORTANT NOTE- o'�m pAm PROJECT: u�-.
pof i i i iTTo '„ F PROFESIOHALSERVICE'HEDOCLIENTHIS1-SEwniAioileomiiEEAiirHE <�imf DR. MARK YOUNG J11ENR �IN�
D n 6 m p DE., DESIGNS INCLUDED HEREIN ARE rHE so PROPERrroF °A DENTAL
MIL AND IRE PROIECIED UNDER COPYRIGHT. o
I I I I I I H `Km HTHEY_ HOT N: USED OR REPRoou -
m O D OF IRI— CONSENT OF HENRY SCHEIN AHD FUIi Pp�i.IEMROF ANY LOCATION: IWp WEST IINCOLN AVENUE
ASSOOATED DESIGN FEE.
n➢➢ m m�m ALL DIMENSIONS ARE SU6IECL TO JO&SITE VERIfiC—N. HYpRA CHARROOTFE�SSgNE �BAUILDING WEi ALLIS. WI 532?)
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, Mark C. Young
[County application name and number]
was provided to Young Property !nvestments the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number 06100-00-00-027A1
manner identified below:
by delivering a copy of the application in the
Hand delivering a copy of the application to Mark C. Young, President,Young Property Investme
[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 May 17th, 2017
Date
Mailing a copy of the application to
[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
to the following address:
[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 IkApplicant
Mark C. Young
Print Applicant Name
May 17th, 2017
Date