HomeMy WebLinkAboutCLE202200085 Application 2022-06-14Zoning Clearance Application
FOR OFFICE USE ONLY Clearance Number:
.'t Albemarle County
Community Development
401 McIntire Rd, North Wing
Charlottesville, VA 22902
Phone 434.296.5832
Fee Amount: $ 61.36 Date Paid: �, 1�j , By:
Application fee: $59 + Technology Surcharge: $2.36
Receipt #: (X P1j(e6 4W YA 169 154C, Check #: Grcd-A' Carl By: 't> eevkV%. lry
Applicant - Fill out the entire page below and return to:
Community Development 401 McIntire Rd, North Wing, Charlottesville, VA 22902
Name:
1*14 vj
E-Mail Address:
k�FJt r"A9-T114Ho9-
Mailing Address:.
\ p GA_tiy4�-`p ti f� Dt riV t 1G VA
Phone #:
434,
Tax Map and Parcel
number and/or Address
of the Business:
e61W® - 05 - 00. Q 1111^0
'bbeI g W'i0t ti7,
Zoning:
Staff will fill out if unknown
Parcel Owner:
0G_T ^7rowE;F'It_I„p Fizc?ERg`f GWUErz
Owner's Address:
b'l5 "lc v" AVC , G PL
"t 0
Check any that apply:
New Business ❑ Change of Use ❑ Change of Ownership a Change of Name
Business Name:
F4 5 G'i wl
Description of Business:
Describe the business including use, number of employees, number of shifts, availability of parking, and any additional info.
6 E AVt o veb d9T O"S.F t1'L-0 Pttowc_I1.t
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:
Z
Is the Parcel Zoned LI, HI, or PDIP?
Yes VNo If yes, fill out a Certified Engineers 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?
FrPublic 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 [v�No If yes, obtain appropriate sign permit and list permit # below
Will there be new construction or renovations?
XYes No If yes, obtain appropriate building permit and list permit # below
Please list any applicable Building Permit #s:
?,> Za 2 2 r ' I
lbz AC,
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. r
Signature /� L - Printed GPI I ram4 #" 1 w1 (tea
Date , 1ry5 . '' QZ'``
2
yoF ^ra
Zoning Clearance Application �$� Albemarle County
O y Community Development
401 McIntireRd, North Wing
Charlottesville,
r �±Chatlottesville,e, VA 22902
CINI�' 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,
clearance number provided by Staff or business name
to 0VTv crt-61JZ 1FA,y 614the owner
Name of landowner on record
of Tax Map and Parcel Number NPI WO -03- oO- WajA b 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. l'J, 'GO2'L to the following address:
535 �/lFd :hor, Avc. G *'^ Ft, Eje'L., `toe_, ""f l oo zl-
(Written notice to the owner and last known address on our record books will satisfy this
requirement. Please see staff for help determVing this information if needed)
Signature of Applicant
/`—
Applicant Name PrintedI►Jk--
Date
M