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CLE202000147 Application 2020-11-12
Zoning Clearance Application Albemarle Rd.N rrty camnungo.o.p rt 401 MGnd, Nq'N wng U 9W ChaAMresWW VA225 Pha 434.2e5.5932 FOR OFFICE USE ONLY Clearance Numberi�� ,z J2 - ozwo! -Q Fee Amount: $).� Date Paid: By: �ie f�AF'IsfCCNED Receipt #: (y Check #: \ by the Albemarle County — ` By �o sDsvelopment Department Applicant - Fill out the entire page below Date /(-IL-Lo And return to Community Development 401 McIntire Rd, North Wing, Z o CharlottesFile c-CE vi "' = ©z(-7 Name: g L n / E-Mail Address: �YA/t ►ti (<(Z �lr Mailing Address: Z751 ( -� � v t r t � _ G �t 4 � `�d-- G• Phone #: 34-91s Tax Map and Parcel 27-901 Zoning: number and/or Address of the Business: 000DJ_i0 f1{J-Di$AQ staff will fill out it unknown Pat reel Owner: Check any that apply: t.B,rGt- CO- ❑ New Business Ej Change of use L7 Change of ownership Change of Name Business Name: � - — - l>n� _C4 1�dI� sacs De3Cfff]]iptFOn of BusineSS: ribe the business including Descuse, number of empbyees, number of shirts, availability of parking, and any additional info. G•- rTM.- d� �- )1%i i'� IT 1 �[M!w f.�_ � d L {1a^Y C,QW �" Previous Business on Site: Floor Plan: Please attach either an 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 fortheBusiness: -- —_ -� % Is the Parcel Zoned LI, HI, Or PDIP? C Yes ^ No If yes, fill out a Certified Erwineer's Re orl fK ER1 - - - -- Yes No If yes, provide Virginia Department of Health approval Will there be food preparation? Is the Parcel on public water or private well? u Public Private If on private well, provide Virginia Department of Heath approval Is the Parcel on public sewer or septic? public Septic If on septic. provide Virginia Department of Heath ❑ Pf 9 P approval Will you be putting up any new signage? Elyes No If yes, obtain appropriate sign permit and list permit # below Will there be new construction or renovations? l__ J Yes �%No If es, obtain a ro date y 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 abiiidde/ by tthrem / (/1// jp/^ (/� Signature +`�" "'�— Printed `J r L` /Wt�r J`VN Date ( 4 5'1) For Albemarle County Staff Review Only Proposed Use: - -k-V't V I Permitted: es ❑ No Permitted by Section: I Ua i\,t K C4 C I Supplementary Regulations: •� Applicable Special Use Permit (SP): ,7-6r2--0— Applicable Rezonings (ZMA): ^ Applicable Site Plans (Sop): Z-02-0_67 G f 6 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 Development. Parking Formula: Defined by: ❑Site Plan ❑Zoning Ordinance [—]COD []Existing Total Square Footage of the Use: �ia0 Required number of parking spaces: _ Associated Clearances: U Variances: `mil g Z$ �5C vl Sz� Violations: '�— Is a site inspection necessary?: ❑ Yes No Site Inspection on (date): To Confirm: Notes: Conditions of Approval: Additional conditions of approval apply to Fireworks and Christmas Trees Approval Information Approved as proposed ❑ 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: z� Building Official Date Zoning Official Date n Z-�Gt[� �t % �l*�teGC Other Official r/�t� Date County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Phone: 434.296.5832 Fax: 434.972.4126 4