HomeMy WebLinkAboutCLE202100158 Application 2021-11-17or+a
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Zoning Clearance Application `0m�°'�°0,NonhW
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FOR OFFICE USE ONLY Clearance Number: t�,CL2
Fee Amount: $ 61.36 Date Paid: �a� �(���� i
Application fee: $59+Technology Surcharge: $2.36 1 O nty
Receipt # #: ByCommunit)r Development Department
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Applicant - Fill out the entire page below and return to: FI a �—
Community Development 401 McIntire Rd, North Wing, Charlottesville, VA 22902
Name:
QAKo F1 Wear. AA-
E-Mail Address:
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Mailing Address:
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Phone III:
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Tax Map and Parcel
number and/or Address
of the Business:
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331 Se
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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
Business Name:
Description of Business:
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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:
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Floor Plan:
Please attach either an architectural drawing or a sketch of the proposed business Indkadng Ne 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:
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Is the Parcel Zoned LI, HI, or PDIP?
Yes ® No If yes, fill out a Certified Engineer's Repoilv�CERj
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 Heats approval
Will you be putting up any new signage?
Elyse 119 No ff yes, obtain appropriate sign permit and list pemtit # 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 #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 abid#y them.
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Signature ter" ' � Printed �
Date 10
e
Zoning
Clearance
Application
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Albemarle County
Communi!/ Dsvabpm t
401 MNnWe Rd. NaN Whg
Chalafl a01k, VA 22N2
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phone 43 M6.W22
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,
A M6 eTTA C C E 20 2 I - 15 9
clearance number provided by Staff or business name
to ' Fiva!5ft;E Me-, LLC. the owner
Name of landowner on record
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
Date1b I2la I I to the following address:
I?o 3 dx 9'Z I ZG 50c.r111 UAkX . 2X - 7 (e 692-
(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
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Applicant Name Printed II A 4A
Date tolAG 621
3
For Albemarle County Staff Review Only
PMMiM War I /1 F L '. I n '',. m✓ r�
Permitted by Section: I t 1 Z'� 1 Supplementary Regulations: j r--�
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Applicable Special Use Permit (SP):
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(Applicable Rozonings (ZMA): r
j Applicable Site Plans (SDP):
Parking: If there is a an�ppro site ite 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 approved Code of Development.
Parking Formula: t 1pp ! rt Defined by: i ❑Site Plan aonlng Ordinance ❑ CoD []Existing
Total Square Footage of the Use:
Required number of parking spaces:
Assoelatad Clearances:
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variances:
violations:
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Is a site inspection necessary!:
I ❑ Yes ❑ No
Site Inspection on (date):
To confirm:
Notes:
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,
Additional conditions of approval apply to Fireworks and Christmas Trees
conditions of Approval:
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
Zoning
Date /�— (
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Phone: 434.296.5832 Fax: 4U.972A126 4
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