HomeMy WebLinkAboutCLE202000109 Application 2020-07-22APPR11V
g$y Albemarle County
zenmJil learance Application c Community Development
Rd, Nwh
Ent MGnsree, A 22 2
Fnw Deve pment Dwp�artmeht Pannewnti
Charlo3429, VP 229n2
"ram �°^a 434.296.5832
Rile F O RFOF FTvz r r 3 E. 011 LY � Clearance Number:(-,/- li�' a 49 ,j v - G> m / 05
Fee Amount: $ 54 Date Paid: j 1 / Z a By: e`1_7
Receipt#: rt)vy!/l/,34 )1-i/ll/4 tmr�cc`( G
By: D a .n -, � .V 4, ,- , / If-s,,;,
Applicant - Fill out the entire page below 6 -111l
And return to Community Development 401 McIntire Rd, North Wing, Charlottesville, VA 22902
Name:
Crozet 00 Am, -I, on�n HQ� j(0S .k1 ttC
E-Mail Address:
C1�(WCIinq. 66 'mctd, al)+,
Mailing Address:
063 Poriviei4l ) (r(72eCV ,L.) 3.2
Phone#:
jY/U sO8 �dh
Tax Map and Parcel
number and/or Address
number
of the Business:
l� b 3 ��rk �; ew r
Cro2ei, VA �2z93)
Zoning -
Staff will fill out ifunknown,
A
Parcel Owner:
�fG t i n ScA tt n, ff h
owner's Address:
L G j i ^ V Lu �v'i . ("; ; r t
Check any that apply:
New Business 0 Change of Use LY'J" Change of ownership 0 Change of Name r,., (r trine,
Business Name:
Description of Business:
Describe the business including use,J number of employees,
number of shifts, availability of parking, and any additional info.
C`Q r7Gi 1Y05 ,ifi !vr 2r�t /� 'e� ,
crFbCl c
S'gme ces Orr? ez;st;,r ei(j nerS,
Previous Business on Site:
C(G 2e.t Vetk..'i nel f C r i CCr9-je
r
Floor Plan:
Please attach either an arrhitectuYal drawing or a sketch of the proposed business indicating the location of uses, the
uses of rooms, the total square footage of the use, and any additional information.
Total Square Footage Used
for the Business:
3 / MS .
Is the Parcel Zoned LI, HI, or PDIP?
❑ Yes No
If yes, fill out a Certified Enoineer s Report (CER)
Will there be food preparation?
UYes JNo
If yes, provide Virginia Department of Health approval
Is the Parcel on public water or private well?
Public Private
If on private well, provide Virginia Department of Health approval
Is the Parcel on public sewer or septic?
Public vseptic
If on septic, provide Virginia Department of Health approval
Will you be putting up any new signage?
❑ Yes J;�rNo
If yes, obtain appropriate sign permit and list permit # below
Will there be new construction or renovations?
❑ Yes VNo
If yes, obtain appropriate building permit and list permit # below
Please list any applicable Building Permit #s:
Zoning Clearance review cannot begin until the application above is complete and all applicable forms and fees are submitted.
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 best of my knowledge. I have read the conditions of approval, and I understand
them, and that I will abide by them.
Signature Printed�i,
Date
SK OF
O` 7 'F
Zoning Clearance Application 1 -
' , i1. tO
Albemarle County
Community Development
401 McIntire Rd, North Wing
Ch.dottesville, VA 2 2
Phone 434,296,5832
Applicant - If you are not the land owner, please fill out the entire page below confirming that you have either
informed or are going to inform the owner of your zoning clearance application.
CERTIFICATION THAT NOTICE OF THE APPLICATION HAS BEEN
PROVIDED TO THE LANDOWNER
certify that I will provide (o(have provided notice of this clearance application,
clearance number provided by Staff or business name
to Melillo 9c)u/M el- r) the owner
Name of landowner on record
of Tax Map and Parcel Number by either delivering a
TMP number of property
copy of the application to them in person or by sending them a copy of the application by
mail. (Please check one of the following below)
u Hand delivering a copy of the application to the owner identified above on
Date E41 9'J'tyAlo
❑ Mailing a copy of the application to the owner identified above on
Date
to the following address:
(Written notice to the owner and last known address on our record books will satisfy this
requirement. Please see staff for help determining this information if needed)
Signature of Applicant
Applicant Name Printed
Date
6Z.1 %/20 Za
3
For Albemarle County Staff Review Only
Proposed Use:
�[,.
Yi^ r—11N i C
Permitted:
es ❑ No
Permitted by Section:
s f g g _6
Supplementary Regulations:
519
Applicable Special Use Permit (SP):
5 Sg-6o
Applicable Rezonings (ZMA):
G q 2 0$
Applicable Site Plans (SDP):
19 % O - 0 3
Parking:
If there is an approved site plan associated with the parcel, the parking requirements will be defined by the SDP. Some
parking requirements are determined by a ZMA or by an approved Code of 9,ovel6pment.
Parking Formula:
l r{(776f ,� ( ,e 1,r,t
Defined by:
❑Site Plan oning Ordinance ❑ Coo ❑Existing
Total Square Footage of the Use:
3
Required number of parking spaces:
�ly�m �. I�rk1 C7 ed - 7 7
c C ! J
Associated Clearances:
I H e ot,
Variances:
Violations:
Is a site inspection necessary?:
❑ Yes ❑ No
Site Inspection on (date):
To Co;;M-.
Notes:
/2
gtt'> c-55 15 If K( Y lrLts5l [`Z j S GL Ix f`s r- (T%Irkt✓b r l"
c Acett
Conditions of Approval:
Additional conditions of approval apply to Fireworks and Christmas Trees
Approval Information
Approved as proposed ❑ Approved with conditions [_ j Denied
❑ Backflow prevention device and/or current test data needed for this site. Contact ACSA, 434.977.4511 ext. 117
❑ No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance
with the existing site plan.
L This site complies with the site plan as of this date.
Conditions:
Additional Notes:
Building Official Date
Zoning Official Date 2-2-7-?)
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Phone: 434.296.5832 Fax: 434.972.4126 4
vz }
�a pti
Sewage Disposal System Operation Permit
Commonwealth of Virginia
Department of Health
Tax Map No.
to Operate a (Type]
Health Department
Identification No,
r'i _on_za
Sewage Disposal System Having a Design Capacity of
Health Department
is Hereby Granted Permission
------- gpd, at
avourvwwry SECTION/BLOCK LOT --_-
This permit is Issued in Accordance with the Provisions of 32.1, Chapter 6 of the Code of Virginia as Amended and Selion(s)of the Sewage Handling and Disposal Regulations of the Virginia Department of Health and
with Previously Issues permits
with the understandi
with the Sewage Her
Issuance of an Oper
Period of Time.
VARIANCES GRANTED
❑ NONE p SI
-- Dated l �z❑_____
that the Owner and/or any Subsequent Owner will operate the Sewage Disposal System in Accordance
ig and Disposal Regulations of the Virginia Department of Health and any Variances or Conditions Granted.
g Permit does not imply or Guarantee that the Sewage Disposal System will Function for any Specified
ATTACHED
Effective Date
C.H.S. 205 Mv.4/so
SPECIAL CONDITIONS
p NONE ❑ SEE ATTACHED
Recommended (Sanitarian) Apptoved (Star; Health Co issioner)
Sewage Disposal System Construction Permit PAGE _(_OF?-
Commonwealth of Virginia Health Department
t EI en f He Ith � I Identification Number &7:7
Health Department AW Map Reference -
_ General information
Repair ❑ Expanded ❑ Conditional ❑
FHA ❑ VA ❑ Case No.
t
e application for a sewage disposal system construction permit filed
in accordance with Section
nstruction per t is ereby issued to:11
C
r*di'
-i i�
-dYiTelephonef
` Sewage disposal sys which is to be constructed on/at , L
on
_1 �Section/Block _
Lot
a
timated water use
---
_
; e (describe)
NOTE: INSPECTION RESULTS
Water supply location: Satisfactory yes noo 0 --
ater suppxistin
l
rTo
be instal
d: class _
comments
G. W. 2 Received: yes p
no ❑ not applicable Qsed
routed
Building se r.
Building sewer:
yes no ❑ comments
—�' I.D. PVC 40, or equivalent.
Satisfactory
Slope 1.25" Per 10' (minimum).
Other
I Septic tank: Capacity [ J�i�C7_ gals. (minimum)-
Pretreatment unit:
es no
Y ❑ comments
❑Other
Satisfactory
Inlet -outlet structure:
I Inlet -outlet structure:
yes no ❑ comments
PVC 40, 4" tees or equivalent.
j Satisfactory
❑ Other --
Pump a primp station:
Pump 3 pump station:
yes ❑ no ❑ comments
No Yes ❑ describe and show design.
if yes: _Y__
Satisfactory
N
Gravity maihs/. or larger I.D., minimum 6" fall per
Conveyance method:
yes no ❑ comments
100', 1500 lb. crush strength or equivalent.
( Satisfactory
❑ Other .
Distribution pox: 7741;- 1 p I S
Distribution box:
yes no ❑ comments
Precast concrete with __ ports.
I Satisfactory
Q Other
Header lines:
Header lines:
yes no ❑ comments
Material: 4" iI.D. 1500 lb. crush strength plastic or equiva-
Satisfactory
lent from dtribution box to 2' into absorption trench.
Slope 2" rhi imum.
F1 Other
/
Percolation lines:
Percolation lines:
yes no ❑ comments
Gravity 4" Plastic 1000 lb. per foot bearing load orl
Satisfactory
equivalent, Slope 2" 4" (min. max.) per 100'.
❑ Other
Absorption irenches:--7,+
JCOI,
Absorption trenches:
yes Id no❑ comments
Square ft. required _ • depth from ground syrfac�
to bottom of trench
Satisfactory
; aggregate size
Trench bottom slope -2--4 ` I tbo'
center to center spacin ,T`L� ; trench width
Date J
Depth of aggregate _ _;
I
cie an a oved b Y
Trench length I i7D—; Number of trenches . I
sanitarian
Health Department
Identification Number
§chematic drawing lot sewage disposal system and topographic features. PAGE OF
Show the lot lines of t� building lot and building site, sketch of property showing any topographic features which may impart on the design of
,the system, all existing and/or proposad structures including sewage disposal systems and wells within 100 feet of sewage disposal system and
reserve area. The schematic drawing of the sewage disposal system shall show sewer lines, pretreatment unit, pump station, conveyance sys-
tem, and subsurfaces 1 absorption syslem, reserve area, etc. When a nonpublic drinking water supply is to be located on the. same lot show all
sources of pollution within 100 feet.
0 The information I required above has been drawn on the attached copy of the sketch submitted with the application.
Attach additional sleets as necessary to illustrate the design. �
16r; vt -0
The sewage disposal system is to be constructed as
C64
/i//g/9/q/ /
;yf l�
12-
f< ttD--1
27°
I I �'Q. N \
t by the permit E or dlspecifications attached plan! a (,.
This sewage disposal system construction permit is null and void if (a) conditions are changed from those shown on t e application (b) condi-
tions are changed from (Those shown on the construction permit. V D
No part of any installation shall be cowered or used until inspected, corrections made if necessary, and approved, by the local health, department
or unless expressly aut razed by the local health dept. Any part of any installation which has been covered prior to approval shall be uncov-
ered, it necessary, upon he direction of the Department. (1
late:
Sate: 3-1 Z
Issued by:
If FHA or VA fin ncing
'Ieviewed by Date
by
Date
I
Construction
l Valid un it
� c+
Supervisory Sanitarian
Regional Sanitarian