HomeMy WebLinkAboutCLE201800115 Approval - County Zoning Clearance 2018-07-24Application for Zoning Clearance = °F Ay�
CLE # i_,.
OFFICE US ONLY
PLEASE REVIEW ALL 3 SHEETS
Check # Date: `'�
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: 061 MO-00-00300 Existing Zoning
Parcel Owner: M & H Realty Seven, LLC
Parcel Address:440 Premier Cr., Suite 230 City Charlottesville State Virginia -zip 22901
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? Pamela Wagner, General Counsel (Virginia Neurodiagnostics)
Address : 4545 Fuller Drive, Suite 100 City Irving State Texas Zip 75038
Office Phone: (469) 995-8416 Cell # 214-415-5044 Fax # 866-279-4704 E-mail brandy.mcclary@afcompanies.cc
APPLICANT INFORMATION Virginia Neurodiagnostics,LLC
Check any that apply: Change of ownership Change of use Change of name x New business
Business Name/Type: Virginia Neurodiagnostics, LLC
Previous Business on this site n/a
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:
Arno il�� a}try dig „SLAG EEG E=KG apcl Hem@ Sleep Testing
*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 m k wle I have r the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed Justin L. Magnuson, CEO of Managing Member
A VAL INFORMATION
[ Vpproved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, x 117.
[ F ] >Kphysical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
st plan.
[ ] This site complies with the site plan as of this date.
Notes:
Building Official Date %
Zoning OfficialIXAD 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 /
Is us m LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y /n
Will re 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 public 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 or public sewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit. ,i� q
Permit # K t %I A O Ci
-
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: 70 U
�/ N
ermitted as:�
Under Section:
Supplementary regulations section: — -
Parking formula: ofA
Required spaces: �' )
Y /
Item e verified in the field:
Inspector:
Notes:
Date:
Violations:
Y/N
If so, List:
Proffers:
Y/N
If so, List:
Variance:
Y/N
If so, List:
SP's:
Y/N
If so, List:
Ar
Clearances:
SDP's
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 M & H Realty Seven, LLC the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number 061 MO-00-00300
manner identified below:
by delivering a copy of the application in the
Q Hand delivering 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
Mailing a copy of the application to M & H Reality Seven, 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 V" ' I A9J to the following address:
Date
M & H Reality Seven, LLC located at 1500 Forest Ave., Suite 100, Richmond VA 23229
[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].
4igne of plicant
Justin L. Magnuson, CEO of Managing Member
Print Applicant Name
Date�,
ALLIANCE
Family of Companies
Pamela Wagner
General Counsel
(214) 415-5044
pamela.wagner@afcompanies.com
May 10, 2018
County of Albemarle
401 McIntire Road
Charlottesville, Virginia 22902
Attention: Department of Community Development
RE: The County of Albemarle Zoning Clearance Certificate — Virginia Neurodiagnostics, LLC
To Whom It May Concern:
Please find enclosed the original Zoning Clearance Application and a check in the amount of Fifty -
Four and No/100 Dollars ($54.00).
Please process and return approved document in the enclosed self-addressed stamped envelope. It
will be greatly appreciated. For questions, concerns and additional information, please feel free to contact
me directly at 469-995-8416 ext. 1159 or email me at brandy. mcclarygafcompanies.com.
Thank You,
A / ' ` . vq
Brandy N. McClary
Paralegal
/bm
Encl.
4545 Fuller Drive, Suite 100 Irving, Texas 75038