HomeMy WebLinkAboutCLE202100076 Application 2021-07-12V
Zoning ClearanceApplication Albemarle County
Community Dmelopmrt
Ch McIntiree. NU Wing
CdadpdeaWle, VA 22902
Phone 630296.5e32
FOR OFFICE USE ONLY Clearance Number: 000-16
Fee Amount: $ 54 Date Paid: 61 Li I a By: AI'CA,�i o -Z v-onatito
Receipt #: 56l9la-1{ 1 %5110 51 LI C Check #:
By: 4<Y(e /i uvi li
Applicant - Fill out the entire page below
And return to Community Development 401 McIntire Rd, North Wing, Charlottesville,
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VA 22902 {
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Name:
.Mail Address:
Mailing Address:
Phone #•
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Tax Map and Parcel
number and/or Address
of the Business:J�Sy��
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Zoning:
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Parcel Owner:
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Owner's Address:
Check any that apply:
EYNew Business Ej Change of Use ❑ Charge of ownership 0 Change of Name
Business Name:
Describe the business including use, number of employees, number of shifts, availability of parking, and any additional info.
Description of BUSIne33:
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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:
/f � 1 0 5 I ��
Is the Parcel Zoned LI, HI, or PDIP?
Yes No If yes, fill out a Certified Enoineer's Report (CERI
Will there be food preparation?
Yes No n/ 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 appropriate s' n yg permit and list permit #below
Will there be new construction or renovations?
El 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 provided is true and accurate to the best of my knowledge. I have read the conditions of approval, and I understand
them, and thl I will abide by them.
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Signature _ i.�+-\_�'; Printed
Data
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For Albemarle County Staff Review Only
Proposed Use:
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Permitted:
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Permitted by Section:
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Supplementary Regulations:
Applicable Special Use Permit (SP):
Applicable Rezonings (ZMA):
Applicable Site Plans (SDP):
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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:
Plan ❑Zoning Ordinance ❑ CoD []Existing
Total Square Footage of the Use:
2-'?0
Required number of parking spaces:
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Associated Clearances:
Zozp- 101 q- 6 Z 20I 7
Variances:
Violations:
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Is a site inspection necessary?:
❑ Yes o
Site Inspection on (date):
ems—
To Confirm:
Notes:
Conditions of Approval:
Additional conditions of approval apply to Fireworks and Christmas Trees
Appr9val 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.
with the site plan as of this date.
❑ This site complies with
Conditions:
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Additional Notes:
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Building Official � � Date
Zoning Official Date
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Other Official VCS Ni%ll�t��l Date r'�21 Z
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Phone: 434.295.51W Fax: 434.972.4126 4
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