HomeMy WebLinkAboutCLE201700161 Application 2017-07-25Application for Zoning Clearance
CLE #_&Oil- 1�1
OFFICE SE O Y
PLEASE REVIEW ALL 3 SHEETS
Check# Date:
Receipt # _. Staff:
PARCEL INFORMAT/IO
Q� " �
Tag Map and Parcel: Ul� `�" lJ Existing Zoning
Parcel Owner: r�QwllS ay\A V L.L , \15 ( +lr
Parcel Address:( W �ikk of cO KA 5v--- { , City i(d,,v )1 U- State VIA 7il).D1
(include suite or floor)
PRIMARY CONTACT
^
Who should we call/write concerning this project? 1jkyty% 'W&q—t
Address : 6n L1 IqA.&u0 City L�W6 kt j tli State A zip "D joI
Office Phone: E-mail u l bLxJJ1&i1, eAu
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use —se�'—Change of name New business
Business Name/Type: ��R �> �FCAM' 4t/ -��
Previous Business on this site F't'")S ' ')h,V--, I
Describe the proposed business including use, number of employees, numh'e((r of shifts, available parking spaces, number of
vehicles, and any additional information that you can provide: bAvv"( tset tom, )
*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 owners 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 J-tv"n -A)
APP OVAL INFORMATION
[ Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, A 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 Z
Zoning Official I A tL. Date
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 9724126
Revised 11/02/2015 Page 2 of 3
Intake to.complete the following:
Y /(l
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /%
W46cre 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 or ublic water.
If private well, provide Health Dep went form
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic o u lic sewer.
Reviewer to complete the following:
Square footage of Use:
TT
Y/N ,n
Permitted as: (J�
Under Section: 1
Supplementary regulations section:
Parking formula: I ,� A diWc
Required spaces:
Y N
Ite verified in the field:
Y/6N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit # Inspector Date:
Y / O Notes:
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Pe rmit #
Zoning to complete the following:
Violations:
YIN
If so, List:
Proffers:
YIN
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
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
, CLE 9 6 11 — //0
[County application name and number]
was provided to
[name(s) of the record owners of the parcel]
and Parcel Number
E:�:nd
ntified below:
delivering a copy of the application to
the owner of record of Tax Map
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
QMailing 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 to the following address:
Date
[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].
ignat e of Ap nt
8 a �) 1 t �,l IA,O
Print Applicant Name
Date
Albemarle County
Planning Application
Community Development Department
401 McIntire Road Charlottesville. V.422902-45�
Voice : (434J 296-5832 Fax : (434) 972-4126
TN1P1 061WI-02-00-00300 ovvner(s): SHISLER,.IAMES D OR ALICE H
Application #I CLE201700161
PROPERTY INFORMATION
Legal Description SACHEM VILLAGE CONDOS UNIT 3 PH I
Magisterial Dist. Rio Land Use Primary Office
Current AFD Not in A/F District Current Zoning Primary C1 Commercial
APPLICATION INFORMATION
Street 4.ddres5 3 90 WHITEWOOD RD CHARLOTTESVILLE, 22901 Entered Bj,
4�pplication Type Zoning Clearance Judy Martinlil
L 'I
Project Albert Family Dentistry PLC
Received Date 07/07/17 Received Date Final Submittal Date Total Fee.
54
Closing File Date Submittal Date Final Total
Paid
574
Re -vision Number
Comments
Legal Ad
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Type Sub licatics Cr mrr exit
'APPLICANT 7 CONTACT INFORMATION
1 ContactT,
L—!t�pe
r e -,! APiMkzn�
Name
I — A—ddress citistate
SHISLER, JAMES D OR ALTCF H. Qni wirrry izr,.
zi Phone pq,---r-ll
KES'IN ALBERT 90 A'HrTEY%OOD ROZZ, STE, 3 CH'bILLC 229 1 3307174633
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Signature of ContractororAuthorized Agent Date