HomeMy WebLinkAboutCLE202300039 Application 2023-03-21M
Zoning Clearance Application
:FOR OFFICE USE ONLY
Fee Amount: $ 61.36
Application fee: $59 + Technology Surcharge: $2.36
Receipt #:
Clearance Number:
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, Noon Wing
Charlottesville, VA 22902
FyACIN�N,
Phone 434296.5832
Name:
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E-Mail Address:
saya�sLr low as o.Gc .
Mailing Address:
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Phone #:
Tax Map and Parcel
number and/or Address
of the Business:
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Gr,0141100i✓✓lg, 414 7-7-g0/
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Zoning:
Staff will fill out If unknown
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Parcel Owner:
(/MANSE 1�k r os 1/0e LC.0
Owner's Address:
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Check any that apply:
New Business Change of Use Change of Ownership Change of Name
Business Name:
o o /! / i LLC J ✓r'
Description Of Business:
Describe the business Including use, number of employees,
number of shifts, availability of parking, and any additional Info.
Previous Business on Site:
(Jyjq y 4-un ��� �l�jic� SrycaJ �NrGQ_
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:
30� s 5-4 Sl=r plr1. It 1i a
s %o/4"V
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Is the Parcel Zoned LI, HI, or PDIP?
Yes [?r'No
If yes, fill out a Certified Engineer's Region ICER)
Will there be food preparation?
Yes 2N0
If yes, provide Virginia Department of Health approval
Is the Parcel on public water or private well?
Ea public Private
If on private well, provide Virginia Department of Health approval
Is the Parcel on public sewer or septic?
ErPublic ❑ Septic
If on septic, provide Virginia Department of Health approval
Will you be Putting up any new signage?
0Yes No
If yes, obtain appropriate sign permit and list permit# below
Will there be new construction or renovations?
0yes Ea o
If yes, obtain appropriate building permit and list penult # below
Please list any applicable Building Permit #s:
at A4" e "07' 911
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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
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