HomeMy WebLinkAboutCLE202100186 Application 2022-01-05V
Zoning Clearance Application
FOR OFFICE USE ONLY Clearance Number: C fIzzor-1 00191p
Fee Amount: $ 61.36
Application fee: $59 + Technology Surcharge: $2.36
Receipt#:y pT 3gW(4Wktp (IB4133y
Albemarle County
Community Devebpment
401 McIntire Rd, North wing
Charlottesville, VA22902
Phone 434,296.5332
By: Mi t
:`PROVED
By: D6nlQ�l.L2.. sut@nitr-5
-ant Department
Applicant - Fill out the entire page below and return to: t'_i-- -2 2-
Community Development 401 McIntire Rd, North Wing, Charlottesville, VA 22902
Date Paid: I21-1121
Check#: NM
Name:
)e_(J 7,o ,ri
E-Mail Address:
Mailing Address:
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Phone #:
Tax Map and Parcel
number and/or Address
of the Business:
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Zoningi
Staff willrllout iunknown
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Parcel Owner:
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Owner's Address:
Check any that apply:
New Business Change of Use Change of Ownership Ej Change of Name
Business Name:
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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 archdedural 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:
(YDD if
Is the Parcel Zoned Ll, HI, or PDIP?
Yes No If yes, fill out a Certified Engineer's Report (CER)
Will there be food preparation?
Yes
No If Virginia provide es, Vir y p g 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?
Yes ❑ No If yes, obtain appropriate sign permit and list permit # below
Will there be new construction or renovations?
Yes KNo If es, obtain appropriate ybuilding 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 i and accurate to the best of my knowledge. I have read the conditions of approval, and I understand
them, a4atlide b them. 'Signature �"' /Prt(itedDate 2
OF ALg
a�> Albemarle County
Zoning Clearance Application :" 40 Adribr.evelorth
401 McIntiree North 2 ng
Charlottesville, VA 22902
��BCIXF� 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 rovide (or have provided) notice of this clearance application,
LoIA PASSA4 �DA CL1, zUz( -116
clearance number provided by Staff or business name
to (X' f �1� f1�( the owner
Name of landowner on record
of Tax Map and Parcel Number 9M ( w-,)Od Nd. 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
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-det"ning 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:
❑ Yes No
Permittedby Section:
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Supplementary Regulations:
Applicable Special Use Permit (SP(:
._
Applicable Rezonings (ZMA(:
Applicable Site Plans (SDP):
2-&c7 - 46
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 proved Code of Development.
Parking Formula:
y,75 / V6iz)apDefined
by. I
Ysllle Plan ❑ Zoning Ordinance ❑ CoD ❑Existing
Total Square Footage of the Use:
it SQQ ctG
Required number of parking spaces:
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7 ct 6�. Ciz' Z (� Z r _ I 2 4e ax,v _ V S 2ov�7 6
Associated Clearances:
'ZOI '112 ZO(6.265 `Zi —/0Z ZOQ-37 Z-010-7-400$-235/ttc
Variances:
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Violations:
Z I/ l o Z Ol'Z- z. ( C A
Is a site inspection necessary?:
❑ Yes ❑ No
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 Official
Date /z-��'�/
✓ `ZZ
Zoning Official
Date
Other Official
Date
Countyof Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Phone: 434.296.5832 Fax: 434.972.4126 4
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