HomeMy WebLinkAboutCLE201800131 Approval - County 2018-06-29GOO"
pate
for Zoning Clearance
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REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # Date: '
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Receipt # Staff
PARCEL INFORMATION
Tax Map and Parcel: 045B1-06-00-001 B0 Existing Zoning
Parcel Owner: Jefferson Realty Partners, LLC
Parcel Address: 2335 Seminole Lane Suite #500 City Charlottesville State Va Zip 22901
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? Monte Tate
Address: 3714 Airport Acres Rd City Charlottesville State VA Zip 22911
Office Phone: (434) 9621249 Cell # 434-962-1249 Fax # E-mail monte.tate@yahoo.com
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name X New business
Business Name/Type: Pain & Spine Center of Charlottesville, PLC
Previous Business on this site Suite has been vacant
Describe the proposed business including use, number of emplo es, number of shifts, av ilable parking spaces, number of
vehicles, and any additional information that you can provide: e_h-1P [ e C-' HAA=Ks rahin
i 1 t bf — f - `1 '. 3a - I Wit 1t>e_ry ul e . -
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*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 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 accurat to Ike best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed 4k<NTN12 Pt71e1%�Z,
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, 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
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 /VN�
Is us in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y //lei
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 or�u�bl'ic�wa;i?
If private well, provide Healt form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies -
Is parcel on septic or p lic sewer?
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, obta' the proper Permit.
Permit #133o ly" I
QLQ
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use:
Y/N
Permitted as:I
Under Section: 9"1 L at)
Supplementary regulations section:
Parking formula:
i 1 aoo kv.+
Required spaces:
Y/N
Items to be verified in the field:
Inspector: Date:
Notes:
Violations:
Y/N
If so, List:
yy
rs I lad 6L�I°ice
Pro e :
Y N
If ist:
riance:
V/N
If so, List:
/ A S s�.zq
SP's:
/N
``ff so, List:
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1G4 --1
Sl' 19 N -1 d
Clearances:
SDP's
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Revised 11/l/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,
was provided to
[County application name and number]
[name(s) of the record owners of the parcel]
and Parcel Number
manner identified below:
Hand 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
= 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, identify 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
EXHIBIT A
Legal Description of the Land
All that certain tract or parcel of land with all improvements thereon and appurtenances thereto
appertaining, situated on the east side of U.S. Route 29 in Albemarle County, Virginia, in the
subdivision known as Carrsbrook, containing 9.934 acres, more or less, designated as Parcel D-
1B on plat of B. Aubrey Huffman, Engineer, dated July, 1962, and recorded in the Clerk's Office
of the Circuit Court of Albemarle County, Virginia in Deed Book 382, Page 309; SAVE AND
EXCEPT the 0.2039 acre parcel shown on plat recorded in the Clerk's Office aforesaid in Deed
Book 851, Page 416; FURTHER SAVE AND EXCEPT that ship or parcel of land taken by the
Commonwealth of Virginia as evidenced by Certificate recorded in Deed Book 1741, Page 63;
AND FURTHER SAVE AND EXCEPT that certain parcel of land containing 0.252 acre, more
or less, as shown on a plat by B. Aubrey Huffinan & Associates, Ltd., dated August 28, 2001 and
recorded in Deed Book 2107, Page 661.
AND BEING the same property conveyed to Jefferson Equity Partners, LLC and Oak Hill
Partners, LLC, both Tennessee limited liability companies, by deed from Riverside Group, LLC ,
a Virginia limited liability company, by Warranty Deed dated December 13, 2013 and recorded
in the aforesaid Clerk's Office on December 19, 2013 in Deed Book 4446, Page 737. Jefferson
Equity Partners, LLC and Oak Hill Partners, LLC have since been merged into the Landlord.
Tax Parcel No. 045B 1-06-00-001 BO
A-1
N KPE 1716713 v3
2824135-000045 08/17/2016
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