HomeMy WebLinkAboutCLE202000179 Application 2020-12-28ab
JAiI emarle County
Zoning Clearance Application ° p 401 Monett, Rd North Wing
Charlotti,,W. VA22902
r>RGINFA Rhone 434.296.5892
FOR OFFICE USE ONLY Clearance Number: CNe o iGaUQCJ �74Q
Fee Amount: $ 54 Date Paid: w\ By. 5Vcr,,(NA�,,� Gceer�
Receipt #: \ O� Check #: ,\ By: t"1sC'f
Applicant - Fill out the entire page below
And return to Community Development 401 McIntire Rd, North Wing, Charlottesville, VA 22902
Name:
Shanniki Green
E-Mail Address:
charlotteannsho mail.com
434-260-2867
p D' S
Mailing Address: 3526 Do wood Drive Palmyra, VA 22963
Tax Map and Parcel 1L 0, _P 0 j
number and/or Address
of the Business: (%1Ctvlatltl2 \/A
VI t Cilliga I
Phone #:
Zoning:
Staff will fill out if unknown
Parcel Owner:
Owner's Address:
Check any that apply:
New Business ❑
Change of Use Change of ownership ❑ Change of Name
Business Name:
Charlotte Ann
Description of Business:
Describe the business including use, number of employees,
number of shifts, availability of parking, and any additional info.
Consi nment Bouti ue
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
for the Business:
I ��I fL
`I
Is the Parcel Zoned LI, HI, or PDIP?
❑ Yes ❑ No
If yes, fill out a Certified Engineer's Report (CER)
Will there be food preparation?
❑ Yes IV No
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 Septic
❑ ❑ P
If on septic, provide Virginia Department of Health approval
PAP 9 P PP
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 E�(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 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.
Signatur7 � VLO Printed Shanniki Green
Date 12- 11 -Zo7
y OF AL
J2� ;�� Albemarle County
Zoning Clearance Application Community Development
401 McIntiree North 2
�!' Ghatlottesville, VA 22982
hRCINF Phone 434.2%.5832
Applicant - If you are not the landowner, please fill out the entire page below, confirming that you have either
informed or are going to notify the owner of your 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,
Gc r7-oLo - (77
to 10001k�,Vtlh k5la) Sailor Matt the owner
of Tax Map and Parcel Number
by either delivering a
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)
E�-' Hand delivering a copy of the application to the owner identified above on
Date 12- 11 Z020
❑ Mailing a copy of the application to the owner identified above on
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 f�)'h(.t n nl o eiye en
Date I Z - 11- ZD 7-0
M
For Albemarle County Staff Review Only
Proposed Use:S(SD
Q I5cffPermitted:
❑ No
Permitted by SectC
"� Z2t Zr i CS
Supplementary Regulations:
Applicable Specia
� L U2—S✓Applicable
dApplicable
RezoniU
Site Pla
Parking:
If there is an approved site plan associated with the parcel, the parking requirements will be defined by the SDP. Some
Parking Formula:
Ir5 lora
Defined by:
I ❑Site Plan Zioning Ordinance ❑ COD ❑Existing
Total Square Footage of the Use:
Z- L
Required number of parking spaces:
6j ey"Gs 0Associated
Clearances:
z-V2_C-31
Variances:
Violations:
Is a site inspection necessary?:
❑ Yes No
Site Inspection on (date):
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.
lNotes:
Date � �D 12,z.
Date G 2— Z5_20
Other Official
Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Phone: 434.296.5832 Fax: 434.972.4126
A-
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