HomeMy WebLinkAboutCLE202100116 Application 2021-09-01Zoning Clearance Application
FOR OFFICE USE ONLY
Fee Amount: $ 61.36
Application fee: $59+ Technology Surcharge: $2.36
Receipt MI a3 �5-,�
Clearance Number: N, I -'U6 It 6
Date Paid: IN4? t
Check #: I09 q
Applicant - Fill out the entire page below and return to:
Community Development 401 McIntire Rd, North Wing, Charlottesville,
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Albemarle County
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Communiy Development
401Mclntim Rd, Wing
Charlottesville, VA 229229 n2
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Phone 434.2965832
By: Ve-e- Cam eA �gj L(K;4 LCC
by the Albemarle County
By:ment Department
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VA 22902
Name:
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E-Mail Address:��
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Mailing Address:
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Phone #:
Tax Map and Parcel
number and/or Address
of the Business:
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Zoning:
Staff will out if unknown
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Parcel owner:
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Owners Address:
Check any that apply:
❑ New Business ❑ Change of Use ❑ Change of ownership ❑ Change of Name
Business Name:
Description of Business:
Describe the business including use, number of employees, number of shifts, availability of parking, and any additional info.
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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:
Is the Parcel Zoned LI HI or PDIP?
❑ Yes No o If yes, fill out a Certified Engineer's Report (CER)
Will there be food preparation?
❑ Yes l❑"No If yes, provide Virginia Department of Health approval
Is the Parcel on public water or private well?
PfPublic ❑ 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 tt obtain appropriate sin ermit and list ❑ Yes,g p permit #below
Will there be new construction or renovations?
❑Yes No If yes, obtain appropriate buildingpermit 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.
Signaiuq r _ �/►� Printed)Q-M,1S01 1 r 1. I't A l-,Q
Date 2
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Zoning Clearance Application Q=� vbemade County
4Community Development
McIntire Rd, North Wing
Charlottesville. VA 2292
hRCIN�� Phone 434.298.5832
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,
to
clearance number provided by Staff or business name
Name of landowner on
the owner
of Tax Map and Parcel Number 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)
❑ 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 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
Date
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For Albemarle County Staff Review Only/ O10
Proposed Use:
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Permitted:
Yes ❑ No
Permitted by Section:
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Supplementary Regulations:
Sect 5r
Applicable Special Use Permit (SP):
Applicable Rezonings (ZMA):
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Applicable Site Plans (SDP):
Parking:
If there is an approved site plan associated withthe parcel, the parking requirements will be defined by the SDP. Some
parking requirements are determined by a ZMA or by an a oved Code of Development.
Parking Formula:
1/10 f I�r W �r
Defined by:
Site Plan ❑Zoning ordinance ❑ coo ❑Existing
Total Square Footage of the Use:
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Required number of parking spaces:
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Associated Clearances:
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Variances:
Violations:
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Is a site inspection necessary?:
❑ Yes ❑ No
Site Inspection on (date):
To Confirm:
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Notes:
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Conditions of Approval:
Addttional conditions of approval apply to Fireworks and Christma Trees 0 ?
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:
Building Officia
Date
Z
Zoning Official
Date
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
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