HomeMy WebLinkAboutCLE202300038 Application 2023-03-21Mill
Zoning Clearance Application
,FOR OFFICE USE ONLY Clearance Number:
Fee Amount: $ 61.36 Date Paid: By:
Application fee: $59 +Technology Surcharge: $2.36
Rebelpt #i 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 Count
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Community Developmea
401 McIntire Rd, North Wing
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Cherloltesvile, VA 22902
Phone 434.296.5632
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Name:
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E-Mall Address:
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Mailing Address:
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Phone #:
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Ta><Map and Parcel -____..
number and/or Address
of the Business:
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Zoning -
Staff will fill out if unknown
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Parcel Owner
Check any jhat apply::
!J Owner s Addressi r"
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New usiness Change of Use Change of Ownership Lj Change of Name
Business Name:
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Descrip ilon of 8usinesS:
Describe the business Including use, number of employees, num er of shifts, availability of parking, and any additional Info.
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Previous Business on Site:
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FIOo"r Plan "
Please attach either an architectural drawing ore 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.
TotaLSquare footage Used.
for the Business:
/10 t r 5 F 7-5 /0� sure.. PKCva2 su�t�ir��a�Q situ¢ C.
1 4• M. F, r g inu/� . f s�• 7S s,�e f P[e�.e s, a 0✓4��40� Plate
Is the Parcel Zoned LI, HI; or PDIP?
Yes [�rlNo
If yes, fill out a CeRiged Encineer's Report (C R1
Will there be food preparation?
_ -... -
Yes No
If yes, provide Virginia Department of Health approval
Is the Parcel on public water or private well?
Opubllc ❑ Private
If on private well, provide Virginia Department of Health approval
Is the Parcel on public sewer or septic?
[✓7Publlc ❑ Septic
if on septic, provide Virginia Department of Health approval
WIII you be pUttir(g l7p'any new'slgnage? _
Yes gNo
If yes, obtain appropriate sign permit and list permit# below
Will there be new constructlonorrenovattonsf
Elyes [?'No
If yes, obtain appropriate building permit and list permit # below
Please list any applicable Building Permit #a:
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
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