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HomeMy WebLinkAboutCLE202100191 Application 2022-01-05,� or
Zoning Clearance Application �} k Albemarle County Wing
Community Development
®m Charlottesville,
McIntire Rd, North Wing
ChatloltesWle, VA 22902
�yRGlt4�r Phone 434.296.5832
FOR OFFICE USE ONLY Clearance NumberC(,E�u 001ct i
Fee Amount: $ 61.36 Date Paid: MAS124 By: Atexar Lr� ST'u m-s
Application fee: $59 + Technology Surcharge: $2.36
II PP trED
Receipt #: I �(.t 12 Check #: L4 t ( ByC)9-,t'1j e(;(.(, •,
'tiVelopment Department
Applicant - Fill out the entire page below and return to: Date 1 5-L2
Community Development 401 McIntire Rd, North Wing, Charlottesville, VA 22902e `" -- —
Name:
4 1 e x g h d i q, L Wood DDS
E-Mail Address:
Wv ad d d 5� y rvm2t(.CON►
Mailing Address:
zyp H jv-Amllc g1ja Ra• S Kite 1 Oz
Phone #:
034)773 _ (yq'L,
Tax Map and Parcel
number and/or Address
of the Business:
CM4r t� a+�� �� VOL. ZZgn t
0(0100-00--00-027A3
Zoning:
Staff wit fillout ifunknown
1
�/ IQ '
` 1
Parcel Owner:
Datlicjlo,5 L. 9farvili Pin
Owner's Address:
& )I draMp�11G Rt e. fu;F
Check any that apply:
® New Business Change of Use Change of Ownership Change of Name
Business Name:
Describe the business including use, number of employees, number of shifts, availability of parking, and any additional info.
Description of Business:
her bcw�i }r c�w�
(o ee" 13ullvles �tou S-5 Mrm -Tltr1 f)xStt
PA*-kiA-
Previous B Inessonsite:
S'}brns WSW Nrlt2wf)vC �Brl t!�
Floor Plan:
Please attach either an architectural drawing 6r a sketch of the proposed busines indicating the location of uses, the
uses of rooms, the total square footage of the use, and any additional information. - ScLn1C
Total Square Footage Used
for the Business:
F b`
1�0� s� ( r-).00 1 lam
Is the Parcel Zoned Lit HI, or PDIP?
Yes No If yes, fill out a Certified Engineer's 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 Ej 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 X 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 willlabide�jb(y� them.DIIISignatureAmyari
f -v V�S.CLa�✓1 ��raR• Printed �lKk�l.Vl(ifct IXk.C'..vn� uVCY't7
Date I - j 0-2-1
2
Zoning
Clearance Application
�_ �11=
O
Albemarle County
Community Development
401 McIntireRd, North Wing
Charlottesville,
Cherla[tesvllle, e, VA 22902
�RG1N13`
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 application,
Starns aket vl3cstd re11eristve bekt.fis�r�
clearance number provided by Staff or busines name
-C-Ez�zl�I�(
to DO L �- Si"uNnS the owner
V Name of landowner on record
of Tax Map and Parcel Number 06 100 nc -cc - DZ 7 A 3 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)
LvJ Hand delivering a copy of the application to the owner identified above on
Date iZ'� l l ZVZ-I
❑ 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 I Z�)
M
For Albemarle County Staff Review Only
Proposed Use:
10
ivCt G C £K� `
Permitted:
Yes ❑ No
Permitted by Section:
17< 2 i 2 10
1 Supplementary Regulations:
.� f Sp
Applicable Special Use Permit (SP):
1 ( [ 7 47 ! t./ i 66i f
(/• CI AID
Applicable Rezonings (ZMA):
i QCq� I
IBC
Applicable Site Plans (SDP):
2-004 _ 6'z .Z 60D_ C
are-4 o WC44
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 roved Code of Development.
Parking Formula:
1 / 69�0Defined
by:
FSlte Plan ❑ Zoning Ordinance ❑ CoD ❑Existing
Total Square Footage of the Use:
5 120
Required number of parking spaces:
2A0 u-6
C c, )d -2 ev-,iC __Q leer- My,/ l
5 q 6,ps �"JY
Associated Clearances:
02z_ O ZOD-13Z
Variances:
ram'
Violations
�-�
Is a site inspection necessary?:
❑ Yes �o
Site Inspection on (date):
To Confirm:
Notes:
�L
eKf flpv /ceVt w 5�
Conditions of Approval:
Additional conditions of approval apply to Fireworks and Christmas Trees
Approval Information
❑ Approved as proposed /proved 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 Offici
Zoning Official
Other Official
of S
Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Phone: 434.296.5832 Fax: 434.972.4126 4