HomeMy WebLinkAboutCLE202200138 Application 2022-10-19Zoning 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
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Albemarle County
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Community Development
401 McIntire Rd. Nomh Wing
Chadottaavllle, VA 229W
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Phone 434.296.5832
Name:
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Mailing Address: 1600 01 d teakCivil*Phone
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Tax Map and Parcel 4
number and/or Address 5-tay �5
of the Business:
E-Mail Address:
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Zoning
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Parcel Owner:
Owner's Address:
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.
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Previous Business on ite:
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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:
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Is the Parcel Zoned LI, HI, or PDIP?
❑ Yes ❑ No If yes, fill out a Certified Enoineer's Report (CER1
Will there be food preparation?
El Yes No If yes, provide Virginia Department of Health approval
Is the Parcel on public water or private well?
g 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?
1/ Yes ❑ No If yes, obtain appropriate sign permit and list permit # below
Will there be new construction or renovations?
❑ Yes
No If es, obtain appropriate buildin
� Yg 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 I will abide by them. Signature Printed fC/� X (5;a IVGL
Date
2
For Albemarle County Staff Review Only
Proposed Use:
Permitted by Section:
Applicable Special Use Permit (Spy
Applicable Rezonings (ZMA):
Applicable Site Plans (SDP):
Parking:
Larking Formula:
Total Square Footage of the Use:
Required number of parking spaces:
Associated Clearances:
Variances:
Violations:
Is a site inspection necessary?:
Site Inspection on (date):
Notes:
Conditions of Approval:
Permitted: ❑ Yes ❑ No
Supplementary Regulations:
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 approved Code of Development.
Defined by: ❑Site Plan ❑ Zoning Ordinance ❑ CoD [—]Existing
❑ Yes ❑ No
Confirm:
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 McIntire Road Charlottesville, VA 22902 Phone: 434.296.5832 Fax: 434.972.4126
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