HomeMy WebLinkAboutCLE202200173 Application 2022-12-29Zoning Clearance Application
FOR OFFICE USE ONLY Clearance Number.
Fee Amount $ 61.36 Date Paid: By:
Application fee: $59 + Technology Surcharge. $2.36
Receipt #: Check #: By:
Applicant - Fill out the entire page below and return to:
Community Development 401 McIntire Rd, North Wing, Charlottesville, VA 22902
Albemarle County
- Community Development
401 McIntire Rd, North Wing
ti't1 h Charlottesville. VA 22902
Phone 434.296. 5832
Name:
Al ,&Pu i ti C° a
E-Mali Address:
Mailing Address:
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Phone #:
Tax Map and Parcel
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Zoning:
number and/or Address
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staff III fill out aunknown
of the Business:
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Parcel Owner:
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owners Address:
y apply:
Check an that a
New Business Change of Use n Chan e of Ownership
� g g p I 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 Site:
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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:2
Is the Parcel Zoned Ll, Hit Or PDIP?
J Yes No If yes, fill out a Certified Engineer's Report (CER) 11
Mil there be food preparation?
Yes No If yes, provide Virginia Department of Health approval
Is the Parcel on public water or private. Well?
U Public n Private If on private well, provide Virginia Department of Health approval
Is the Parcel on public sewer or septic?
[z Public !' Septic If on septic, provide Virginia Department of Health approval
Will you be putting up any new signage?
[vYes No If yes, obtain appropriate sign permit and list permit # below
Will them be new construction or renovations?
/ Yes i� No If yes, obtain appropriate building permit and list permit # below
Please list any applicable Building Permit #s:
zonz _ o -, ro e -A I
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 th
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Signature -�- Printed AJ, l�A1 6-171-1
Date /2 ,[yF / '1n 77 2