HomeMy WebLinkAboutCLE202100125 Application 2021-09-20Zoning Clearance Application
FOR OFFICE USE ONLY Clearance Number: CLO IoO) (-PS
Fee Amount: $ 61.36 Date Paid: 919-,1'
Application fee: $59 + Technology Surcharge: $2.36
Receipt#: )23700 Check#: il0a3
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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Community Dev ,b nt
401 McIntire Rd, Nm Wing
CMrlot "Ne, VA 2n02
Phone,IN196.5832
By: (pro Z e_,4APftftEUt&
by the Albemarle County
ByCommunity Development Department
Date
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VA 22902
Name:
LCrD 0.ZI e_%1 hin,, j 6q�
ail Address:
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Mailing Address:
27
Phone #:
Tax Map and Parcel
number and/or Address
of the Business:
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Zoning:
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Parcel Owner:
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Owners Address:
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Check any that apply:
New Business Change of Use Change of ownership Change of Name V)A! 2,ZgSt
Business Name:
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Description of Business:
Describe the business including use, number of employees, number of shifts, availability of packing, and any additional info. ,
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Previous Business on Site:
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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, NI, or PDIP?
Yes No If yes, fill out a.Certified Engineers 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?
�z Yes No If yes, obtain appropriate sign permit and list permit # below
Will there be new construction or renovations?
Yes WNo 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 b hem. ✓/A
Signature Printed / y4a-t/
Date v C%z'-,%�� /
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For Albemarle County Staff Review Only
Proposed Use:
Permitted:
es ❑ No
Permitted by Section:
2 0 D, Z C
Regulations:
Applicable Special Use Pemnit(SP):
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Applicable Rezonings (ZMA):
Applicable Site Plans (SDP):
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Z D D $ - 4 ! R $) ` � ` y it QL(
Parking:
If there is an approved site plan asso6ated 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 f Development.
Parking Formula:
V/teao � CV CD
fined by:
❑Site Plan Psoning Ordinance ❑ CoD ❑Existing
Total Square Footage of the Use:
D S r ZD r dry
Required number of parking spaces:
5' (� t,--
Associated Clearances:
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Variances:
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Violations:
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ece
Is a site inspection necessaryd:
❑ Yes Drft
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:
Building OfRcial Date��/�
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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