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HomeMy WebLinkAboutCLE202200097 Application 2022-07-22Zoning Clearance Application FOR OFFICE USE ONLY Fee Amount: $ 61.36 Application fee: $59 +Technology Surcharge: $2.36 Receipt #: Clearance Number. Date Paid: By: Check #: By: Applicant - Fill out the entire page below and return to: Community Development 401 McIntire Rd, North Wing, Charlottesville, VA 22902 pf �i. Albemarle County J M r rR,,l�\� Pliorw 43/.286.58V Name: l �� E-Mail Address: S/LI�i�QP Mailing Address: jqkt2. Phone#: Del Tax Map and Parcel !13A number and/or Address J"s�Tck?-�IvVq of the Business: 1 C'jgm4 is (Zd '2-OLn q L4 bbDCto 000 GO Zoning: Staff wllfill out ifunkrovm Parcel Owner: owners Address: U / c Check any that apply: New Bustness Charge of Use Change of ownership Change of Name Business Name:Lczk�-jo (t L Description of Business: Describe the business including use, number of employees, number of shifts. avaiabi ty of Par", and any additional trdo. CCU/ YVAD-V✓-'O�jl� C venom 5i� GtL V1 �✓� eL`� Previous Business on Site: Cop%, 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: aoirr Dec-k- /oV 1 U131IO " (y'v Is the Parcel Zoned Ll, Hl, or PDIP? as No If yes, fill out a Certified Engineers Report fCERt Will there be food preparation? Q>el No If yes, provide Virginia Department of Health approval Is the Parcel on public water or private well? n Public ©-rmate if on private well, provide Virginia Department of Health approval Is the Parcel on public sewer or septic? Public epic If on septic, provide Virginia Department of Health approval yt Will you be putting up any new signage? ❑ Yes E31NO If yes, obtain appropriate sign permit and list permit # below Will there be new construction or renovations? B es No If yes, obtain appropriate building Permit and list permit # below Please list any applicable Building Permit #s: (!� �0)0 _ O j�� �/4 C_ Zoning Clearance review cannot begin until the application above is complete and all applicable fors 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 owners 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. SignatureIAA�Printed C Li ( W Date 2 CV I L bz-f ov ety Albemarle county Zoning Clearance Application i-'` " � �°°"A �� �, cnergeaMa, VA 719N2 �r6GIN�i Pr 43/3Na5833 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 PLL,n Z LG the owner Name of landowner on record of Tax Map and Parcel Number n,WbO600 00()2�Co 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 ailing a copy of the application to the owner identified above on Date to the following address: 1 LA'q--2--?—W3 (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 3 For Albemarle County Staff Review Only Proposed Use: Permitted: ❑ Yes ❑ No Permitted by Section: Supplementary Regulations: Applicable Special Use Permit ISM: Applicable Raxonings (ZMA): Applicable Site Plans (SDP): Parking: Parking Formula: It there Is an approved site plan associated with the parcel, the parking requirements will be defined by the SDP. Some parking requirements are determined DeefienaMr b[]SIt Pland oZo^Ing Order ce ❑ CoD ❑Fxdsting Total Square Footage of the Use: Required number of parking spaces: Associated Clearances: variances: Violations: Is a sma Inspection necessary7: ❑ 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 Zoning Official Date Other Official Date County of Albemarle Department of Community Development 401 Mdndre Road Charlottesville, VA 22902 Phone: 434.296.5M2 Fax: 434.972.4125 4 tiew s t _ �51 Sw„aca,, Sao"�o 130� (��ex}1k:l3 desk- s,2)�I-