HomeMy WebLinkAboutCLE202200087 Application 2022-06-16FOR OFFICE USE ONLY Clearance Number 2Q 2-Ll- —W O71 �q
Fee Amount: S 61,36 Date Paid: f (�c�2 BY'DQn� ,eue, C�j"s^r`-"iv6
Application fee: YSg/1• TeohnNngy Sumhnrge. $2.36 V1 can
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Receipt #: C.0 . Check #: ` I' By: IWU 1.1.1.r t I
Applicant - Fill out the entire page below and return to:
Community Development 401 McIntire Rd, North Wing, Charlottesville, VA 22902
�Name: E-Mail Address:
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Mailing Address: ! !Q � Phone M:
60LTax Map and Parcel Zoning:
number andlor Address � �3� Slsir w/N eYouteunknown
of the Business:
Parcel Owner: jkj�(#JOL ant ,i S I owner's Address: ' o Y
Ch@ck any that apply: 0 New Business Change of Use Change of ownership Change of Name
Business Name: ins •t
Description of Business' Describe 0e business including use, number of empl ees. number of Shuts, availability of parking, and any additional info.
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Previous Business on Site:
Floor Plan:
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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:
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Is the Parcel Zoned Li, HI, or Ii
Yes XNo if yes, flit out a Certified Engineer's Report (CER)
Will there be food preparation?
Yes :R_No if yes, provide Virginia Department of Health approval
Is the Parcel on public water or private well?
,ublk: ❑ Private If on private well, provide Virginia Department of Health approval
`Public
Is the Parcel on public sewer or septic?
[] septic tl on septic, Ixovide 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 No If yes, obtain appropriate building permit and list permit # below
Please list any applicable Building Permit Its:
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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 Ili
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 j
information provided is true and accurate to the best of my knowledge. 1 have read the conditions of approval, and I understand
them, and that I will abide by them.
Si natur� Printetl
Date b °I C-L 2
i
Albomarlo county
Zoning Clearance Application
11-n .y ye sett
Applicant - It you are not the land ownnr, please rill 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 e5 y✓1 may" 5 the owner
Name or landowner on record
of Tax Map and Parcel Number lot- 1311, 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)
i
Hand delivering a copy of the application to the owner identified above on
Date fo' t u- 3 a
J 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 /, (Z'-Z>
Applicant Name Printed Kar.rck
Date b q 2 a
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