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HomeMy WebLinkAboutCLE202100148 Application 2022-01-21Zoning Clearance Application s= r?FCR1tr' FOR OFFICE USE ONLY Clearance Number. C,Ne, onca\- \ 1AZ Albemarle County COMMU Nty Devebpwffl 401 W1nde Rd, Nwn Wing Che ".n rile, VA 22902 J� Phone 434 96.5832 11�' Fee Amount: $ 61.36 Date Paid: \()j 0-10-j I aj By: CUA \ o,- pb Application fee: $W * Technology Surcharge. $2.36 APPROVED Receipt#: 1,3� Check#: at j U By: �y Albemarle County lJ Commlllll/bbevelopment Department Applicant - Fill out the entire page below and return to: Date Community Development 401 McIntire Rd, North Wing, Charlottesville, VA0902 Name:,IC E4Aail Address: Mailing Address 00 ."d n <( ✓a e � 0 P— Tax Map and Parcel number and/or Address of the Business: «« lJ C� ��x Zoning: Staff Wilfin out ifunknown tt�� {If II 11 Parcel Owner.. Sol bwnelsAddress: 5 I rtyl I A �qel Check any that apply: ❑ New Business ❑ Change of Use Change of Ownership ❑ 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. Previous Business on Ske: 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: % ^'ry lv I Is the Parcel Zoned Ll, HI, or PDIP? ❑ Yes © No ayes, fill out Certified Engineer's Report ICER) WHI there be food preparation? Elyffi © 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? M Public ❑ Septic If on septic, provide Virginia Department of Health approval Will you be putting up any new signage? Ej yes Q No If yes, obtain appropriate sign permit and list permit # below Will there be new construction or renovations? n Yes g 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 II will abide by them. n Signature C � � r Primed Ti' S /1 Date �1 �/. -� �_ C7 a 2 Zoning Clearance Application FOR OFFICE USE ONLY Clearance Number: Fee Amount: $ 61.36 Application fee: $59+ Technology Surcharge:$2.36 Date Paid: By. Receipt #: Check #. By. Applicant - Fill out the entire page below and return to: Community Development 401 McIntire Rd, North Wing, Charlottesville, VA 22902 Name: Mailing Address: Tax Map and Parcel numbatand/or Address of the Business: Parcel Owner: Check any that apply: Business Name: - Description of Business: Previous Business on Site: Floor Plan: Total Square Footage Used for the Business: New Business the E-Mail Address: Phone Zoning: Staff will fig out if unknown Albemarle County Commumry Oevelopmem L rt 4al Mdn]re Rd. Nnt wM1np c, ChaMaesWe, VA 22PW �d'GYF� Rhone434.296.5a12 Owner's Address• Change of Use Change of ownershipF, Change of Name any 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. l Zoned Ll, HI, or PDIP? food preparation? IJ Yes J No Yes NoPublic l on public water or private well?`� ttE Private on public sewer or,septic? r--1_. U Public U Septicutting up any new signage? Yes � Na Will there be new construction or renovations? r� yes E No Please Ifst any applicable Building Permit #s: If yes, till out a clkd!e LngQM' R o01 CERI If yes, provide Virginia Department of Health approval If on private well, provide Virginia Department of Health approval If on septic, provide Virginia Department of Health approval If yes, obtain appropriate Sign permit and list Permit K below If yes, obtain appropriate building permit and list permit a below 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 2 ��OrA Albemarle County VOIDPWeN Zoning Clearance Application 401 Mchlry Rd,NOMW n C MCNBre.. A22 Wing T+Charbtteshlle; VA 22982 �RCrina Phone 434.2N.8832 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, CL- -(`t8 clearance number provided by Staff or business name to -9c, d'n CP)(C L L42 I LC, the owner Name of landowner on rewrd _ of Tax Map and Parcel Number C' 7FCx)-c (- ( --% by either delivering a TMP number of properly 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 Pk koz) to the following address: L4, / l ou l win (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 C I'L_ ---k V , 1 Applicant Name Printed —c:� -/ f 12/ 7 IL- s s C' Date 3 For Albemarle County Staff Review Only 11 Proposed Uae: Permitted: Yes ❑ No Permitted by Section: (� 2 I( Z i I L Z p p Supplementary Regulations: Applicable Special Use Permit (SP). `-- ApplicableRezonI(ZMA): �-- Applicable Site Plans (SDP): Parking: If there is an approved she 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 gtDovelopment Parking Fommle: "6 pd Doflned by. ❑Sfte Plan ring Ordinance ❑ Cod ❑Existing Total Square Footage of the Ilse: 6' Required number of parking $paws: Z— CyGY-r, Associated Clearances: 20Z--D3 ZDLI-2-309-ZOIr 2491Z-Z5 `16 Z04-2,56 -W e c Variances: —� Violations: is a atis inspection necessary?: ❑ Yes No Sib Inspection on (date): To Confirm: V(. Nobs: 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 Offici Zoning OHicia Other Official Date ` Date l " Zl -Z 2 County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Phone: 434.296.5832 Fax: 434.972.4126 4