HomeMy WebLinkAboutCLE201700218 Application 2017-10-09APPROVED
by the Albemarle County
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Application.on n_g_ earance
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # T7 Date: C® 260
Receipt # Staff. ,
PARCEL INFORMATION
Tax Map and Parcel: Parcel # 03200-00-00-04300 Existing Zoning PDMC
Parcel Owner: Columbia II Hollymead, LLC
Parcel Address:229 Connor Drive, Suite 16A City Charlottesville State Virginia Zip 22911
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? Chad Hinman - L2M, Inc.
Address : 811 Cromwell Park Dr., Suite 113 City Glen Burnie State Maryland Zip 21061
Office Phone: 4( 10) 863-1302 Cell # Fax # 410-863-1308 E-mail chinman@L2M.com
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use X Change of name X New business
Business Name/Type: Pivot Physical Therapy
Previous Business on this site Charlottesville Pediatric Dentistry
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:
Physical Therapy QffiGe (nop-ppedir-Q.1.1 Ao Doctor) Open Mo-n-Rri 7arpJpm. F=wll-twpqQ Staff — 6
*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 Chad Hinman - L2M, Inc.
APPROVAL INFORMATION
4AO'Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, 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 Date 16 1A �1111;r
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/N
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y /
WillRtere 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 blic wa
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that ap ' s�sew
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Is parcel on septic o ub
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 Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: 3 1 3 r f 2—
Y/N �^
fitted as: f°A I (o) 4 FT14�
Under Section: a A,`L
Supplementary regulations section:
Parking formula:
Required spaces:
Y/N
Ite to be verified in the field:
Inspector Date:
Notes:
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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, Zoning Clearance
[County application name and number]
was provided to Columbia If Hollymead, LLC. the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number 03200-00-00-04300
manner identified below:
Q Hand delivering a copy of the application to
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
0 Mailing a copy of the application to Columbia II Hollymead, LLC.
[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 09-27-2017
Date
to the following address:
1 Independent Drive, Suite 114, Jacksonville, FL 32202
[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
Chad Hinman
Print Applicant Name
09-27-2017
Date
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