HomeMy WebLinkAboutCLE202300034 Application 2023-03-20Zoning Clearance Application
FOR OFFICE USE ONLY Clearance Number:
Fee Amount: $ 61.36 Date Paid: By:
Application fee: $59 +Technology Surcharge: $2,35
Receipt # - Check M 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, North Wing
Chadoge ivIle, VA 22902
"he01Nl� Phone 434.296.6932
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Name:
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E-Mail Address:
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Mailing Address:
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Phone #:
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TascMap and Parcel' "'
number and/or Address
of the Business: -- :_ _-
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Parcel Owner,
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OwrieF's Address-.-
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Check any that applyc.
New Business Change of Use Change of Ownership Change of Name
Business Name,
Description of Business:
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Describe the business including use, number of employees, number of shifts, ova ability of parka , and any additional Info.
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Previous Business on Site:
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Floor Plan:
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Please aftectt either an architectural drawing or a sketch of the proposed business Indicating the location of uses, the '
uses of rooms, the totalsquare footage of the use, and any additional Information.
Total Square Footage Used-
for the Business:
290! s� Pec...e S�47rrc»'sO ev^ an FL-" S.,/P 104-11,
Is the Parcel Zoned LI, HI; or PDIP?
Yes [�r'No If yes, fill out a Certified EnolneW Reoort f a,
Will there be food preparation?
yes No If yes, provide Virginia Department of Health approval
Is the Parcel on public water or private well?
�rPubllc ❑ Private If on private well, provide Virginia Department of Health approval
Is the Parcel on ptiblfc sewer or septic?
Public ❑ Septic If on septic, provide Virginia Department of Health approval
Wlllyou be piltting tTp"any new signage? ""- -
0-yes El No If yes, obtain appropriate sign permit and list permit# below
Will there be new construction ortenovatlona?
❑ Yes [�INo If yes, obtain appropriate building permit and list permit # below
. -Pe
_. .. - applicable
Please list any applicable Building Permit #s:
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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
Date
2
2 M.nlns Floor Plan • ExIMIna
FU nsky ARemate Capacity Check
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29.0911
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Vroand Floor Plan • Exlalln0
UMANSKYJEEP
ALTERNATE FACILITY
CHARLOTTEVILLE, VA 2133600
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Payment Receipt
Your transaction has been successfully
completed!! r�
Your Confirmation number is : 1452765105
Transaction ID: 23031710514036FF7189D23031710514
03/17/2023 11:53:36 [EST]
Account
Information
Payment Type: Tax Payment
Bill Payer
Detai is
Christopher Ayers
901 Witlow Ridge Rd
Troy, VA 22974
Payment
Detai is
Payment Amount: $306.80
Convenience Fee: $7.67"
Total Amount: $314.47
Payment Method: 0
Card Number:
XXXXXXXXXXXXX1009
Expiration date: 05/2027