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Home My WebLink AboutCLE202200156 Application 2022-12-08 (2)Zoning Clearance Information ts azioxiijiM Cjwar? A Zoning Clearance is verification from Albemarle County that a proposed use, whether it is a new business or other activity (see Zoning definition of "Use"), satisfies all requirements of the Albemarle County Zoning Ordinance and ensures public health and safety. A Zoning Clearance Application is reviewed by the Zoning Department, Building Inspections Department, as well as any other applicable departments or agencies. LAZon"19 Clearanceis Required in the Following Circumstances � Opening a new business • Changing or expanding an existing business • Buying an existing business Moving a business to a new location or changing its name • Before natural resource extraction • Any uses listed in Section 5 of the Albemarle County Zoning Ordinance as requiring a Zoning Clearance Ak R".IflT� �01�3j3�]t ft)!' � Zonint� Ci��$tfCe Before filling out a Zoning Clearance Application ensure you have or have done the following: Tax Map and Parcel number or Address of the property, Include suiteluniUfloor number, it applicable. Description of the proposed business/use. Include any and all relevant information such as a description of the business, the number of employees, number of shifts, availability of parking, etc. [� A Floor Plan. A sketch or an architectural drawing of the total square footage of the use. If using less than the entire structure, note the location within the structure. Note the square footage of and use of each room. Provide notice to the owner if the applicant is not the owner. Within ten days of applying for a zoning clearance, the applicant, if they are not the owner of the parcel and/or structure, shall inform the owner that they have applied for a Zoning Clearance. Please fill out the form on page 3. • Other Approvals/Documents if applicable. • A Certified Engineer's Report is required if the parcel is zoned Industrial (LI, HI, or PUP), • Health Department approval is required for food preparation or if the parcel is on private well or septic. • Bakeries require USDA approval. • Any additional approvals the Zoning Administrator may require including Department of Social Services and Fire + Rescue. • If you have any questions feel free to contact Staff at (434) 296m5832 Submitting a n Application Once you have all the required information provided above: 1. Fill out an application. Please complete page 2 in its entirety. 2. Submit an application. Bring or send a completed application to Albemarle County Communfty Development at 401 McIntire Rd, North Wing, Charlottesville, VA 22902 I Pay. The application fee can be paid for in person or online. If paying online please attach a copy of your payment re- ceipt Atoning Clearance Application will not be processed until payment has been received. 4. Notify the Owner. If you are not the owner of the property piease fill out page I � Zoning Clearance A FOR OFFICE USE ONLY F Amount $ 61 x36 ApOcabon fee: SW * Technology Sumbarge, $2.3, Rec*lpt #�r ication Clearance Number,4 Date Paid: Check #: -- " ,,_.X. ►-�%a- --, ..r._- - ._a. ... .., - ,s- --s Applicant -Fill out the entire page below and return to: By,: By: Community Development 401 McIntire Rd, North Wing, Charlottesville, VA 22902 Albemarle County Co mnw+ty D*vW0'W1 401 McIntire Rd, Noah VVino ChaftttvsA19t VA 22802 Phone 434.296.6 _ - -e. _ %e 'ft i - F - �, • - &• . Name,* � E44alql Addross, � S 14t a- : J M8#liig Add][%;**, Rvssrr lugCir�c►r 64a�,,'�tL VA ZZtI p3 Phone �.ZTS �' 1-� Tax Map and Parcel number $ndl*r Address��:tl�.� of the Business: E AA a *^ �0+., VC VA 12103 Zoning, say win �i out ff u wn ----- rc Pa�I on:rs:��, T46%)•t � a�9 h Ownees Address.. 0�.��►�S lJkta� wPo:w a Joe 2L lod Check any that apply; � New Business � Change of Use � Change of Ownership � Change of Name ustnP.S.4 Name.. S K..�1� � �a r►'.i 1'�e �: c� � L L-- C Descn*ption of BuS1R£SS; describe the business including use, number of employees, number of shifts, availability of parking, and any additional info. �A1"� � t_-1 Mid: c: c�.� � ra•�:�Ct.t .� � 4--111r> � 4 �'� �� re. � �.cIPICM 4re. S � `lam, /' [� S �"� G A 1 ��i► Tiooi Astt( k4tiq nP M � ek 1' A0 PISVIOUS Business on sit-80 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. TotW Square Footage Used. fo-rtfw Bus1ness. Z ; �j S9 odic fee Is the Parcel Zoned U, NI, or Pnlp? � Yes � No If yes, fill out a Certified Engineer's Report (rk..,`ER) Will there be food preparation? � Yes � No If yea, provide Virginia Department of Health approval Is the Parcel an public water or private well? � Public � Public Private Septic If on private well, provide Virginia Depaent of Health appnaval If on septic, provide Virginia Depa ent of Health approval Is the Parcel on public sewer or septic? Will you be putting up any new signage? � Yes � No If yes, obtain appropriate sign permit and list permit #below Wilt there be now construction or renovations? � Yes � No If yes, obtain appropriate building permit and list permit #below Please list any applicable SuIlding Permit #S: CA Ff-A cl�w U S� Zoning Clearance review cannot begin until the application above is complete and all applicable farms 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. hereby certify that 1 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 ha% P. rPar tha �r nrl'fin►,c r%f,.,�r,,,,.�� them, and that I will abide by them. Signature1 4' ..Oejq Date _ fo2 �/1Zc� Z W UFFI%jya 7 0" u"uumiana PrintedVrA -r A KJ 2 Is Zoning Clearance A ion Albemarle County Community Development 401 McIntire Rd, North Wino ChBrloaesvlle, VA 22902 Phone 434.296.5832 Phcant - If you are not the land owner, please fill out the entire page below confirming that you have either informed or are going toinform the owner of your zoning clearance application. CERTIFICATION THAT NOTICE OF THE APPLICATION HAS BEEN PROVIDED TOTHE LANDOWNER certify that I will provide (or have provided) notice of this clearance application, 5k to VAiJ11S� Phlew� 4 A A P LLC clearance number provided by Staff or business name Name of landowner on record the owner okk 'Oev .,r, LA i of Tax Map and Parcel Number ck4fir (cA '(V vA iaxi o3 by either de TMP number of vooertv copy of the application to them i8n person or by sending them mail. (Please check one of the foil owing I iverin 9 a 41 a copy of the application by below) � Hand delivering a copy of the application to the owner identified above on Date 12. 1 1 1Z'C' L Z ❑ 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 Applicant Name Printed 1 e Date Z 3 EXHIBIT "A" Attached to the Lease Agreement between the UVA FUL tidation and Skyline Family Medicine, LLC dated November 11, 20229 PREMISES FLOOR PLAN irl a � •� «+i JJJ M .. NM1�N.AKWAA�M4Y11y ri : �M+ S �, �Y'!K�W�". d4C w"�►'i� - 0 e I I L +w.wyvw.�N/nV+b. w�a �•R M�hil0.�1.M1►q�NW►AMV.I�A�AVNA.ARaJ��1.�AV�J\AAA.A�h�\MM�C�M.Y1w�+AAri�V�YMNLO.ANMA.7�AA.RAC\M�\J�V��VU�Ai►Mi�PA.��.��.i��M�1.A+Aw��vW.J\G4Aiw1�tJ�Ai�J�N�Wi.A�.wM..iw�.• - _ _ - 145 Ednam Drive, Suite 214 k r�.oyrw 145 Egnam Drive 14 Rev. 04-09-2021