HomeMy WebLinkAboutCLE201800137 Approval - Agencies 2018-06-29Application for Zoning Clearance�"'�,oQ��,ar,
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE QNILY
Check # Date: (D4"\\\\
Receipt # Staff:
PARCEL INFORMATION '
Tax Map and Parcel: 061 WO-0 1 -OA-0009BO Existing Zoning C-1 Commercial
Parcel Owner: PMJB Land Trust
Parcel Address:2340 Commonwealth Dr., Suite 202 City Charlottesville State VA Zip 22901
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? Sue A. Albrecht
Address : 80 Roslyn Forest Lane City Charlottesville State VA zip 22901
Office Phone: (434) 973-6161 Cell # 434-531-2435 Fax # 434-973-0732 E-mail sue@designenvirons.com
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name X New business
Business Name/Type: DEANNA WILCOXSON DODD / Sole Proprietorship
Previous Business on this site Parker, McElwain & Jacobs
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:
Psychotherapy Practice, 1 employee, 1 shift, no company vehicles
*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 accurat o the best wledge. I haverIld the conditions of approval, and I understand them, and that I will abide by them.
Si Printed Sue A. Albrecht
PROVAL 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 (L
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
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 PMJB Land Trust
[name(s) of the record owners of the parcel]
and Parcel Number 061 W-01-OA-009B0
manner identified below:
the owner of record of Tax Map
by delivering a copy of the application in the
0 Hand delivering a copy of the application to PMJB Land Trust
[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 5/23/2018
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, 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].
Sue A. Albrecht
Print Applicant Name
5/23/2018
Date
Intake to complete the following:
Y / T
Is use m LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
YIQ
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 u tic water?
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 applies
Is parcel on septic o lic sewer
Y / N 'PCO4,pi !/,
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: -NV
YIN
Permitted as: a-cksTlCyty n
Under Section: 1� ) . 1� . I CID Y
Supplementary regulations section:
Parking formula: _
Required spaces:
YIN
Items to be verified in the field:
Inspector Date:
Notes:
Violations:
Y N�
If sC'Z,ist:
Pro rs:
Y kNN,
If so, List:
Variance:
(�
If o, moist:
SP'
Y fNJ
If so, List:
Clearances:
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Revised 11/1/2015 Page 3 of 3
Commonwealth Executive Center - Suites 202 &203 Layout
SCALE: NTS
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PROJECT NAME: Commonwealth Executive Center
340 Commonwealth Dr.
CHARLOTTESVILLE, VA 22901
DESIGN ENVIRONS CORPORATION
DESIGNED . BUILT • FURNISHED • INSTALLED
SINCE 197E
REVISIONS:
DATE: BY:
DRAWN BY: IRENE VOLENICK
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Kimball,
Suites 202 & 203 Layout
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DATE: 5/23/18 SCALE: nts
340 GREENBRIER DRIVE CHARLOTTESVILLE, VIRGINIA 22901