HomeMy WebLinkAboutCLE201800087 Approval - County 2018-07-03Application for onin Clearance
CLE #
PLEASE REVIEW ALL 3 SHEETS
PARCEL INFORMATION
Tax Map and Parcel: 07700-00-00-04700
Parcel Owner: Hillcrest LLC
OFFICE USE O.NLLY
Check # Date: '
Receipt # staff- vcaua
Existing Zonin Commercial
Parcel Address: 32 Mill Creek Dr., Suite 109 & 110 City Charlottesville
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? James B. DiCarlo, DVM
Address :1320 Barclay Hill City Charlottesville
Office Phone: C_J Cell # 434-242-7603 Fax #
State VA
State VA
Zip 22902
Zip 22901
E-mail jbdicarlo@gmaii.com
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name x New business
Business NamelType: Willow Creek Veterinary Services, LLC
Previous Business on this site Bloop, Universal Video
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:
*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 pennission 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.
4"
Signature Printed James B. DiCarlo
APPROVAL INFORMATION
[ ] Approved as proposed [ ] Approved with conditions [ ]Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 9774511, 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
Zoning Official
Other Official
Date
Date /
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
Intaakke to complete the following:
Is ]�N]
Is u LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y
Wi a 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 ubli )water?
If private well, provide Het 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 or i@ sewer
WN
l you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
IN
ill there be any new construction or renovations?
If so, obtain the proper Permit.
Permit# `to -zAO ft-L'
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: -Z -Z'
R / itted as: ij�1'.L/1, w 8 i inuj �nI
Under Section:
Supplementary regulations section: 5 . ` 11
Parking formula:
Required spaces: LQ
YI
Items to be verified in the field:
Inspector
Notes:
Date:
Violations: Proffers:
Y / *�T Q/ N
If so``, i st: If so, List:
q9 —Z1
Vari Po",
'
Y / N
If so, List: List:
Clearances: SDP's
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 (Some 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 Hillcrest LLC the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number 07700-00-00-04700 by delivering a copy of the application in the
manner identified below:
QHand delivering a copy of the application to Denise LaCour 1 Hillcrest, 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]
k�,
on 1'� 12 y �'
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] .
e oftlican0
Si a
James B. DiCarlo
Print Applicant Name
� l
Date
T. /3I
IJ � � -�- fi