HomeMy WebLinkAboutCLE201700209 Application 2017-09-12Application for ZoninT Clearance
��; "`� x Ji1 �Y
�,;
CLE #� 12 - C
�. 0
��
a - r
OFFICE U E r
PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Receipt # I I UMP Staff:
PARCEL INFORMATION
Tax Map and Parcel: 04561-06-00-001130 Existing Zoning Highway Commercial
Parcel Owner: Jefferson Equity Partners LLC & Oak Hill Partners LLC
Parcel Address:2335 Seminole Trail, Suite 2000 City Charlottesville State VA Zip 22903
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? Kristin Cory
Address: 1845 Fendall Avenue Citri, Charlottesville State VA Zip 22903
Office Phone: C___) Cell # 4342276882 Fax # E-mail kristin@kcoryconsulting.com
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name x New business
Business Name/Type: UVA Primary Care Riverside
Previous Business on this site
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:
Medical practice for patient care. Currently 18 employees with up to approx 30 employees. Primary Care hours: 8am-5pm Mon -Friday, Walk -In Care hours. 9am-9pm Mon- Friday
and 8am-5pm Saturday. 30 employee and up to 30 patient vehicles at any one time will share the 328 available parking spaces in Riverside Center with other tenants.
*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 anew Zoning
Clearance will be required.
1 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 Kristin L Cory
AP kOVAL INFORMATION
['Approved as proposed ( ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977�511, x117.
[ ] 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 `'G?/ Date
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) 9724126
Revised 11/02/2015 Page 2 of 3
Intake to complete the following:
Y /®
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y / ITT
Will 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 well o ubliA�watct
If private well, provide Healt form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that ap
Is parcel on septic ov@ublic sewe
N
Will you be putting up a new sign of any kind? If so, obtain proper I
Sign permit
Permit# V LL REQUIRE SUKATE
Y/N {_RMIT
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit # B2017--636AC
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: I �) 4 SIS b _ pfZ
Y/N
BMnitted as: 0 5`1( Q
Under Section: .Z `I . Z, 1 t,18)
Supplementary_ regulations section: n/ th
Parking formula: , !
;zee '�10;336 x, �S)
Required spaces: 4
Y/
Itei verified in the field. -
Inspector
Notes:
Date:
VioK�ions:
Y IiN)
If so, ist.
K'tr'�Y�tiyS ra�zl�o�'1U�11
���t
Pro qq
Y N
If so, List:
(Tkiance:
Y N
so, List:
SP's:
N
Q0, List:
1 191 -1
I1g2" 3-R
I` g - 10
Clearances:
201_ 4-7
SDP's
2a{�- 3y
�o�Z- cc,
Ise..i q
Zc,���31� 14
0 . lf,::3
6nf--. ^ 5
d 256,
E
2r?C� I- I t t 9q
200-7 — 2gr
146 i.acp ZI
Revised 11/1/2015 Page 3 of 3
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,
[County application name and number]
was provided to Jefferson Equity Partners LLC & Oak Hill Partners LL the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number 045B1-06-00-001130
manner identified below:
by delivering a copy of the application in the
0 Hand delivering a copy of the application to Norm Brinkman,
[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
Q 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; identif}� 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 of Applicant
Print Applicant Name
Date