HomeMy WebLinkAboutCLE202200145 Application 2022-11-01OF Areej
Zoning Clearance Application
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FOR OFFICE USE ONLY
Fee Amount: $ 61.36
Application fee: $59 + Technology Surcharge: $2.36
Receipt #:
I �RCtN1D
Clearance NumberC(t
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
community Development
401 McIntire Rd. NOM Wing
Chadottesville, VA 22902
Phone 434.296.5832
Name:
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E-Mail Address:
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Mailing Address:
590 V
Phone #:
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Tax Map and Parcel
0 1 -OS -0L -ova{ A0
Zoning:
number and/or Address
2;Lol( 5�,'rwt+. Lat•
Staff will fill out if unknown
of the Business:
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Parcel Owner:
Owner s Address:
New Business ❑ Change of Use ❑ Change of Ownership ❑ Change of Name
Check any that apply:
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 o Site:
—fay
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:
.2 p Q 5
Is the Parcel Zoned LI, HI, or PDIP?
❑ Yes No If yes, fill out a Certified Engineer's 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?
Wpublic ❑ Private If on private well, provide Virginia Department of Health approval
Is the Parcel on public sewer or septic?
public ❑ Septic B on septic, provide 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 pe mk #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 her y certify that I ow r have the o is permission to use the space indicated on this application. I also certify that the
inform on provid tru and accur o the best of my knowledge. I have read the conditions of approval, and I understand
them, an I id e y e
Signature Printed J & C.[C- v y
Date
2
OF A)
Albemarle County
Zoning Clearance Application "` 401 Mom"Y. Norm Development
401 McIntiree North Wing
hChatlotlesville, VA 22902
y$ y}D 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 ke-V maviv5 ( LL • the owner
Name of landowner on record
of Tax Map and Parcel Number 045'9pcf\ U 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)
2 Hand delivering a copy of the application to the owner identified above on
Date 10 !o o lz
❑ Mailing a copy of the application to the owner identified above on
Date to the following address:
(Written notice to the owner and
requirement. Please see staff fo
Signature of Applicant
Applicant Name Printed
Date
is on our record books will satisfy this
this information if needed)
3