HomeMy WebLinkAboutCLE201700176 Application 2017-07-27Application for Zoning Clearance=�°YA`p
CLE #�(j - _�1
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # Date:
Receipt # 16ti [qi� Staff:
PARCEL INFORMATION
Tax Map and Parcel: 1p�}(o'yh 1- (� — C6(6 — (6Ki1,00 Existing Zoning �� G
Parcel Owner: S" 541-k-ek S4a.A : ail LL ii
2GT ryKr c►, 0'4ek 1,J C-LV- AvL
Parcel Address: Stw i E+ 160 City (-N de(o E VS U-6 State Vk Zip -Lily
(include suite or floor)
PRIMARY CONTACT -�—
S { �� ► (Y' �A 1 cX n^
Who should we call/write concerning this project? -� Q ci
Address : a1 S 'J City C�Na r�d t�'��r State Zi aa90�
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Office Phone: (�) 9 Cell # Li®°I' (g Fax # E-mail�l�
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: � � h" ' , , —t) , (;--:l �U � A M a, p � � S -- C,p � P
Previous Business on this site_ n Q \-J (-,AS`^ (+ '�^ �� ---,
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: ,5-e.-4- A-wo ne..c... ��d...ncl�.y�.+-- -
*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 hav th o er's permission to use the space indicated on this application. I also certify that the information provided
is true and ac o the be t o edge. 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, 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 /
Zoning Official J7C✓ 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
;dam
Revised I1/02/2015 Page 2 of
Intake to complete the following:
Y/N
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/N
Will there 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, u is wat ?
If private well, provide Health artment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that apF5�
Is parcel on septic or
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 PernQ t.
Permit#
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: Z 2.
YO/N I1 1 0
Permitted as: Mal -Al 1 C�l <ci
Under Section: 25 A .`Z , l
Supplementary regulations section
Parking formula: 4) 5
�j
Required spaces: / 3
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
Viol ons:
Y /
If so, List:
offers:
�/ N
If so, List:
Vari ce:
Y /
If so, List:
SP's:/ l
Y / �
If so, List:
Clearances:
SDP's
Revised 11/1/2015 Page 3 of 3
Application for Zoning Clearance- Dr. J. M. DiGirolamo, P.C.
Applicant Information Addendum -
Describe the proposed business including use, number of employees, number of shifts,
available parking spaces, number of vehicle, and any additional information that you can
provide: Optometry office with six to seven employees operating one shift per day, six days a
week, utilizing up to seven shared parking lot spaces with five to six additional spaces used per
hour by office consumers.
Floor Plan:
- Total Square Footage
o
2,968 sq. ft.
- Square
footage of each room
o
Exam Room- 110 sq. ft.
o
Exam Room- 102 sq. ft.
o
Exam Room- 102 sq. ft.
o
Exam Room- 102 sq. ft.
o
Doctors' Office- 112 sq. ft.
o
Contact Lens Room- 102 sq. ft.
o
Contact Len Storage- 45 sq. ft.
o
Visual Field Room- 66.5 sq. ft.
o
Pre -Test Room- 71 sq. ft.
o
Pre -Test Room- 71 sq. ft.
o
OPTOS Space- 46 sq. ft.
o
Business Office- 95 sq. ft.
o
Optical Laboratory- 47 sq. ft.
o
Patient Lavatory- 71 sq. ft.
o
Staff Lavatory- 58 sq. ft.
o
Staff Lounge- 159 sq. ft.
o
Optical Retail- 975 sq. ft.
o
Storage Room- 19 sq. ft.
o
Storage Room- 19 sq. ft.
o
Hallway- 282 sq. ft.
o
Reception- 52 sq. ft.
Application for Zoning Clearance- Dr. J. M. DiGirolamo, P.C.
Applicant Information Addendum- cont'd
- Floor Plan cont'd
- Space Usage
o Exam Rooms- Examine patients
o Doctors' Office- Administrative work space
o Contact Lens Room- Administrative/Instructional space
o Contact Lens Storage- Storage space for Trial lenses
o Visual Field Room- Work/Storage space for Diagnostic Instruments
o Pre -Test Rooms- Interview/Administrative Space
o OPTOS Space- Work/Storage space for retinal imaging instruments
o Business Office- Administrative work space
o Optical Laboratory- Storage of frames and lenses
o Patient Lavatory- Bathroom
o Staff Lavatory- Bathroom
o Staff Lounge- Breakroom
o Optical Retail- Area for adjustments and sales of eyewear
o Hallway- Transit area between clinical rooms
o Storage Rooms- Office Supplies
o Reception- Administrative area for clinic
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PHONE: 47d.977.2020
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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, CLA^ k"
[County application name and number]
was provided to 'S"% is trek Vo.4 ,w U*-AC-.ILf L-L,G the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number 0-4GM'L-A4- 04 - CP02 040 by delivering a copy of the application in the
manner identified below:
Hand delivering 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
)Eil— Mailing a copy of the application to S{h S+(-ELA s+OA:dn V-enkt MS LL L
[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 C6-+/ to the following address:
Date
S Sowkinwts f 13,oo A St. Su -A-*. T3 1�a.�Sc„�n C-%X ?962,13
[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].
Signatuk of Applicant
Print Applicant Name
Date