HomeMy WebLinkAboutCLE202000113 Application 2020-08-24,tpF
Albemarle County
Zoning Clearance Application �91_ Community Development
p1 Gh McIntireN2Wing
Ch
!.._ *!arlonesWlle, e, VA 229g2
'xClNll Phone d .295.58K
FOR OFFICE USE ONLY Clearance Number: &(,Il- o2D 20 oOUI 13
Fee Amount: Date Paid: 4N 1 ?v By: 4 j) A, +�)
Receipt M Check #: C By: APPROVED
Applicant - Fill out the entire page below by the hPibe llarle County
svl e,
And return to Community Development 401 McIntire Rd, North Wing, Char RZZ9t Departrrlent
ZY- r
Name:
E-Mail
Mailing Address:
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Phone #:
0
Tax Map and Parcel
number and/or Address
of the Business:
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Zoning:
Staff will fill out itunkni
Parcel Owner:
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Owner's Address:
r
Check any that apply:
New Business ❑ Change of Use Change of Ownership ❑ Change of Name (�-1 rG
Business Name:
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Description of Business:
Desc a business inclu ing use, n of employees, number of shifts, availability of parking, and any additional info.
Previous Business o
e:
Floor Plan:
Please attach either In architectural 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:
'n--
Is the Parcel Zoned LI, HI, or PDIP?
Yes No If yes, fill out a Certified Engineers Report (CER)
Will there be food preparation?
DYes NK0 If yes, provide Virginia Department of Health approval
Is the Parcel on public water or private well?
ublic Private If on private well, provide Virginia Department of Health approval
Is the Parcel on public sewer or septic?
ublic Septic If on septic, provide Virginia Department of Health approval
Will you be putting up any new signage?
Yes No If yes, obtain appropriate sign permit and list permit # below
Will there be new construction or renovations?
Yes No 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 provid is true and accurate to the best of my knowledge. I have read the conditions of approval, and I understand
them, and that I II a ide by them.
signature n, 20 Ile 0 Prin1ted Y� � 1'V ft Y �I�r�\ (y"}e
Date
2
IM
W—(L-
y OF
Zoning Clearance Application �_ Albemarle County
Community Development
n 401 McIntire Rtl, Wing
Ch
_ ,h• C�arlonesNlle, VA 229229 02
`Iglf. Phone 436.296.5832
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
I certify that I will provide (or have provided) notice of this clearance application,
Gt-E zo2.0 -1( 3
clearance number provided by Staff or business name
to �i �L pC t`� the owner
Name of landowner on record
of Tax Map and Parcel Number � ( M -1 `-1- 2'�— 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)
IN Hand delivering a copy of the application to the owner identified above on
Date—T
❑ Mailing a copy of the application to the owner identified above on
Date to the following address:
(Written notice to the owner and
requirement. Please see staff for
Signature of Applicant
Applicant Name Printed
Date
known address on our record books will satisfy this
%determining this information if needed)
3
For Albemarle County Staff Review Only
Proposed Use:
Permitted:
loes ❑ No
Permitted by Section:
L is Z , ( C
Supplementary Regulations:
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Applicable Special Use Permit (SP):
K q
Applicable Rezonings (ZMA):
Applicable Site Plans (SDP):
2 6)19$.— 195 .--3)
✓plan
Parking:
If there is an approved site 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 Development.
Parking Formula:
�( ZDD Q
Defined by:
to Plan
ning Ordinance ❑ CoD ❑Existing
Total Square Footage of the Use:
Required number of parking spaces:
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Z O
Associated Clearances:
2J 6rY- 22 (ci e k 'A 20 tpC — Z 7
Variances:
f
Violations:
Is a site inspection necessary?:
❑ Yes No
Site Inspection on (date):
To Confirm:
Notes:
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Conditions of Approval:
Additional conditions of approval apply to Fireworks and Christmas Trees
App5pval Information
Approved as proposed � 1 Approved with conditions
❑ 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.
❑ This site complies with the site plan as of this date.
Conditions:
Additional Notes:
Building Official �GrGZ/,�
Date U/ter/
Zoning Official
Date C/ Z (� w
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