HomeMy WebLinkAboutCLE202000174 Permit 2021-03-16OF
Albemarle Count
Zoning Clearance Application " McInitie Dithrekipincit
Rd, North Wing
Charlottesville, VA 22902
APPROVED 1 �2kGIN1T Phone 434.296.6832
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FOR OFFICE USE ONLY ClearancebyidliIiIIIIIAW6adek0awrtily
commun,(y /? r� vela ent Departm t
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Fee Amount: $ 54 Da vid: / By: yd!L.
Receipt #: d 4 a �/�� ChEk -`
Applicant - Fill out the entire page below
And return to Community Development 401 McIntire Rd, North Wing, Charlottesville, VA 22902
Name:
�1Qj0AVPVX
E-Mail Address:
Ktr�.�I J • CIL 1
Mailing Address: ��(Z S , PC-, o s Dr';ve
Phone M
a!_z4-t - ILK -c 394
Tax Map and Parcel
number and/or Address
of the Business:
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N„ Qa.e
Zoning:
Staff will fill out ifunknown
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Parcel Owner:
r�
CwW 1"t L 1 nnvlr ;6
Owner's Address:
ro k&-SiSm, 6 11e Va ZZaC
Check any that apply:
❑ New Business r Change of Use Change of Ownership ❑ Change of Name
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Describe the business including use, number of employees, number of shifts, availability of parking, and any additional info.
Business Name:
Description of Business:
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Previous Business on Site:
V <o& "q
Floor Plan:
Please attach either an architectural drawing ore 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:
,
I2-x14 +P.,Nef-
Is the Parcel Zoned LI, HI, or PDIP?
Yes Q No
If yes, fill out a Certified Engineer's Report (CER)
Will there be food preparation?
Yes ® 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
If on septic, provide Virginia Department of Health approval
Will you be putting up any new signage?
Yes ® No
If es, obtain ap
propriate ppropriate 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:
3
Zoning Clearance review cannot begin until the application above is complete and all applicable forms and fees are sd5mitted.
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 C" ��_ _ Printed kerik L>rwW S'�oi^
Date )) ITj 20zsb
I.;i.L
tk1wl
,� oe
a�(M Albemarle County
Zoning Clearance Application; 401McImireRdNorth
401 McIntire W North Wing
Charlottesville. VA 22902
�2RG1NV'' Phene 434. 2965832
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,
to cwt� ..l;,, zrM�rl,rr��,,ti:�theowner
of Tax Map and Parcel Number 3 Z- Zy 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)
Hand delivering a copy of the application to the owner identified above on
Date
Mailing a copy of the application to the owner identified above on
Date ►t/�I Lr(Zc to the following address:
C�OV SC�tic1Ast�C_,Ize � ra hnc 11112-170ty�sA�o
(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 f"
Applicant Name Printed k"ik t 'r'k�
Date 11(L IZOZO
9
For Albemarle County Staff Review Only
Proposed Use:
i�"b M'C 5
Permitted:
Yes ❑ No
Permitted by Section: S
Supplementary Regulations:`
5
Applicable Special Use Permit (SP):
Applicable Rezonings (ZMA):
Applicable Site Plans (SDP):
Parking:
If there is an approved site plan associated with the parcel, the parking requirements will be defined by the SDP. Some
Parking Formula:
Defined by:
❑Site Plan oning Ordinance ❑ CoD ❑Existing
Total Square Footage of the Use:
Required number of parking spaces:
r
": L
Associated Clearances:
Variances:
Violations:
�
Is a site inspection necessary?:
Yes ❑ No
Site Inspection on (date):
�12�2
To Confirm:
iNotes:
1
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.
I Conditions: I � I - _ _ . . It - r I - n .
Additional Notes:
Building Official �Qz2 ` f" b-ZO-Zt�ol W Date
Zoning
Other
Date g/ 1`e 1'91
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Phone: 434.296.5832 Fax: 434.972.4126 4