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Home My WebLink AboutCLE201800035 Application 2018-02-20101541 Application fo Z$nin Clearance 0- # �� U DOr OFFICECLE USE ONLY PLEASE REVIEW ALL 3 SHEETS Check # . n Date: 1-9- r Receipt # 1�•1, ��'�'[� Staff: PARCEL INFORMATION Tax Map and Parcel: 061 ZO-03-00800 Existing Zoning �l Parcel Owner: Our Lady of Peace Inc. Parcel Address: 751 Hillsdale Drive City Charlottesville State VA Zip 22901 (include suite or floor) PRIMARY CONTACT Who should we call/write concerning this project? Lynette Anzalone Address : 101 East State Street City Kennett Square State PA Zip 19348 Office Phone: (610 ) 612-5681 Cell # Fax # 610-347-4948 E-mail Lynefte.AnzaloneC@GenesisHCC.cory APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name X New business Business Name/Type: Genesis ElderCare Rehabilitation Services, LLC PreviouE Business on this site Unknown 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: Provide physical occupational and speech therapy services to the res*dents of Our Lady of Peace, an assmsted Hyingf rolty *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 1 own or have the s permission to use the space indicated on this application. 1 also certify that the information provided is true and accur best of know dge. 1 have read the conditions of approval, and I understand them, and that I will abide by them. Signature Printed Robert M. Cannon, Sr. Director of Accounting AP OVAL INFORMATION [y1c,kflowroved as proposed [ ] Approved with conditions [ ) Denied [prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, xl 17. hysical 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 t'�2dG < Date Zoning Official Date Other Official Date i-ounry o► Atuemarte uepartment 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: YIN Is m LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y!N 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 well o public water. If private well, provide Hea artment form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that Is parcel on septic r public sewer: Y/N Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # W CVto l eobv\4t, V1 ger c4c rm It Y/N Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # Ietv\/e, ,\ seP<rmF, Vj1(!,,,4. Zonine to complete the followine: Reviewer to complete the following: Square footage of Use: 476 Sa ft Y/ e fitted as: Under Section: PUP Supplementary regulations section: Parking formula: I I'L qt Required spaces: Y N Ite be verified in the field: Inspector Date: Notes: Vio s: Y Ifs fist: r ers: Y/ List: ' Y. V73i If o, List: � 1-7 1cl!a6- � Clearances: `2cc'` - Rt SDP's Loil '1041 ,V,��-33 P — L Revised I I/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, Application for Zoning Clearance [County application name and number] was provided to Our Lady of Peace Inc. the owner of record of Tax Map [name(s) of the record owners of the parcel] and Parcel Number 061 ZO-03-00-00800 manner identified below: 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 Eli Mailing a copy of the application to C/O Robert McNichols, Our Lady of Peace Inc. [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 C) I /O q (e to the following address: Date 3333 Peters Creek Rd. N W, Roanoke, VA 24019-1042 [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]. Z a LN Signature of Applicant Robert M. Cannon, Sr. Director of Accounting Print Applicant Name nlloq& Date County of Albemarle - GIS-Web - Property Information http://gisweb.albemarle.org/GISWeb/Propertylnfo.aspx Parcel ID: 061ZO-03-00-00800 Parcel Assessment Data (CAMA) Last Updated On: 07/07/2017 Other Parcel Data Last Updated On: 12/31/2017 GIS/Mapping Data Last Updated On: 12/31/2017 Summary Information Parcel Information Total Acres 6.95 Primary Prop. Address 751 HILLSDALE DR Other Address N/A Property Card(s) 2 Lot 00800 Property Name Our Lady of Peace Subdivision Branchlands Notes L-3 BRANCHLANDS /OUR LADY OF PEACE / 08/13/2009 DB 3784 PG 321 (DEED OF DEDICATION) 7.000 - .051 AC DEDICATED TO PUBLIC USE = 6.949 AC PER PB 3784 PG 326. Owner Information Owner OUR LADY OF PEACE INC Address C/O ROBERT MCNICHOLS 3333 PETERS CREEK RD N W ROANOKE VA, 24019-1042 Owner as of Jan 1st OUR LADY OF PEACE INC Most Recent Assessment Information No recent assessment information available Most Recent Sales History Previous Owner N/A Owner OUR LADY OF PEACE INC Sale Date 07/15/1998 Sale Price $0 Deed Book/Page 1725/066 Other Tax Information as of Jan 1st State Code Charitable Tax Type Exempt Parcel Level Use Code Home For The Elderly Appraiser RHW of 1 1/2/2018 11:12 AM