HomeMy WebLinkAboutCLE202100134 Application 2021-10-13of
Albemarle County
Zoning Clearance Application Community Development
401 McIntire Rd, NMh Wing
k„ ChadoaesWlle, VA 22802
r�gNV� Phone 434.296.5832
FOR OFFICE USE ONLY Clearance Number: a Ca I— 0013q APPROVED
Fee Amount: $ 59 + 4% Technology Surcharge Date Paid: qo-o%% By: ((���..f�iet t �'iYjj>e-ibeinar je County
Receipt#:atrN7ygggD9�ta�13�� Check#: By.tl+>i�y"LDevelOpment artment
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Applicant -Fill out the entire page below File ----
And return to Community Development 401 McIntire Rd, North Wing, Charlottesville, VA 22902
Name:
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E-Mail Address:QO
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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:
Sta%will fill out if unknown
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Parcel Owner:
Owner's Address:
Check any that apply:
New Business Change of Use
hange of Ownership Ej 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:
1600
Is the Parcel Zoned LI, HI, or PDIP?
Yes !o
If yes, fill out a Certified Engineer's Report (CER)
Will there be food preparation?
Yes 2No
If yes, provide Virginia Department of Health approval
Is the Parcel on public water or private well?
0ublic 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 [g,'ko
If yes, obtain appropriate sign permit and list permit # below
Will there be new construction or renovations?
Yes Flo
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 by them.
Signature
Date��
I M,
,f OF
2� Albemarle County
Zoning Clearance Application °°mmOe°Y°e4
401 McIntire Rd.,North wing
*• Wing . Gharlotlesville, VA 229 22902
Phone 434,296.5832
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 �1.
application,
clearance number provided by Staff or business name C L � %
2. 0 L 1 -� I
to Name of landowner on record the owner
/mil1l0 M (-00-00-00101)
of Tax Map and Parcel Number TMP number of property 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 '� '14 I I to the following address:
!�-SLA/ 61-(%,cS'j �\-Jcn 6A
(Written notice to the owner and last known address on our record books wi(I satisfy this
requirement. Please see staff for help determining this information if needed)
Signature of Applicant
Applicant Name Printed
Date
3
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):
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Applicable Rezonings (ZMA):
D(��
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Applicable Site Plans (SDP):
2 Dt Q C' 2 07_ D z-
Parking:
If there is an approved site plan associated with the parcel, the parking requirements will be defined by the SDP. Some
parking requirements are determined by a ZMA or by an a roved Code of Development.
Parking Formula:
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Defined by:
Ite Plan ❑ Zoning Ordinance ❑ COD ❑Existing
Total Square Footage of the Use:
6 0n
Required number of parking spaces:
7 GZ "Q �S � Li1 e r 5DPZ otg •- L C
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Associated Clearances:
�Z
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Variances:
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Violations:
Is a site inspection necessary?:
❑ Yes [q4o' -
Site Inspection on (date):
To Confirm:
Notes:
Conditions of Approval:
Additional conditions of approval apply to Fireworks and Christmas Trees
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 Officl
Zoning Off icia
Other Official
Date l0"t13
Date It? —1) zI
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Phone: 434.296.5832 Fax: 434.972.4126 4