HomeMy WebLinkAboutCLE202100117 Application 2021-10-13V
Fdbemarle County
Zoning Clearance Application 401 Winti Development
not rxmrree, rmnnwry
%.ne leaville. VA22902
a' PM1one 436.296.5932
FOR OFFICE USE ONLY Clearance Number. 'tl 6a 1— 00117 APPROVE
Fee Amount: $ 54 Date Paid: 0%1 By: 1;A I-4 ~County
Receipt #: to 3 $5-y Check #: I Dab By: I9M � OMent Department
l _ /0-13-2(
Applicant - Fill out the entire page below Hie
And return to Community Development 401 McIntire Rd, North Wing, Charlottesville, VA 22902
Name:
E-Mail Address:
Mailing Address:
ne #:
_ O
Tax Map and Parcel
number and/or Address
of the Business:
/ 70 n A4 �� nl
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Zoning:
sratrw;urmoaritu,ka�a
j.�
611.E
Parcel Owner:
owner's Address:
5
Check any that apply:
, /
l/', New Business
Change of Use Change of ownership Change of Name
Business Name:
Description of Business:
Describe the business inclugli
use, number oteinployees, number of shifts, availability of parking, and an additional info.
Previous Business on Site:
S
Floor Plan:
Please attach either an architectural Awing or a sketch of the proposed business indicating the location of uses,
uses of rooms, the total square footage of the use, and any additional in/omiation.
Total Square Footage Used
for the Business:
ny�
Is the Parcel Zoned LI, HI, or PDIP?
_
Yes No It yes, fill out a Certified Engineers Report (CERI
Will there be food preparation?
Yes [Ft No If yes, provide Virginia Department of Health approval
Is the Parcel on public water or private well?
Public Private If o private well,
� p provide Virginia Department of Health approval
Is the Parcel on public sewer or septic?
" �
ry Public Septic If on septic, provide Virginia Department of Health approval
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 No If yes, obtain appropriate building permit and list permit # below
Please list any applicable Building Permit #a:
1
Zoning Clearance review cannot begin until the application above is complete and all applicable forms
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. 1 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
Date a�/i/ter
M
Z_
yel
For Albemarle County Staff Review Only
Proposed Use:
fR
q
Permitted:
es El No
Permitted by Section:
\
'Zy, Z,t L l� ZZ,Z,` Lb (
SupplementaryRegulations:
Applicable Special Use Permit (SP):
Applicable Rezonings (ZMA):
r�r
Applicable Site Plans (SDP):
2-Do(- 55 : z000 - I Li 8 z-OD 6 - ((Z 2I101{ -- lO
Parking:
if there is an approved site plan associated with the parcel, the parking requirements will be defined by the SDP. Some
Parking Formula:
200
Defined by. I
Nifte Plan ❑ Zoning Ordinance �❑ CoD —Existing
Total Square Footage of the Use:
2_45
UDILe
2Lpt - I t / 2019--zir5(' Z.oD6' 6 L
Required number of parking spaces:
Associated Clearances:
Variances:
"""'"
Violations:
2 015- (, j
6
4t-d
Is a site inspection necessary?:
❑ Yes
Site Inspection on (date):
�-
To confirm:
Notes:
Conditions of Approval:
Additional conditions of approval apply to Fireworks and Christmas Trees
Approval Information
r
❑ Approved as proposed r ❑ Approved with conditions Denied
i
❑ 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.
` Condidws:
Additional Notes:
Building Offici
Zoning Officia
Other Official
l0'13
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Phone: 434.296.5832 Fax: 434.972.4126 4
Zoning
Clearance
Application
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Albemarle County
Community
Rd, Noon
Optmift.eRd.A
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CM1arlotlesville. VA 22902
22 2
Phone 434.296 Mn
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 / P 601111 the owner
�
of Tax Map and Parcel Number (jO S �/�n1 �UIS �� �� 10' Vb'y 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
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
3
KALA Ayurveda I
�A
Exhibit A
SUPPLEMENT TO LEASE DATED: 8/14/2019
BETWEEN: Heathrr IliKhlower, LLC d/b4a The Center for Focal Slud% (Tenanp AND
Ballif Investments, I.LC (Landlord) AND
Management Services Corporation of Charlottrsrille (Agent)
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FLUOR
i a R
Trnant's Initials R
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