HomeMy WebLinkAboutCLE202300040 Application 2023-03-21S
Zoning Clearance Application
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:FOR OFFICE USE ONLY Clearance Number:
Fee Amount: $ 61.36 Date Paid:
Applicetlonfee $69 + Technology Surcharge: $2,38
Receipt# "" Cheek#:
Applicant - Fill out the entire page below and return to:
Community Development 401 McIntire Rd, North Wing, Charlottesville,
By:
VA 22902
Ov �
Albemarle County
JI.. community Development
401 Mclndre Rd, Nonh Wln9
Chsdanes01le,VA22902
Phone 434.296,6832
Nlame:
5
E-Mail Address:
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Mailing Address:
130 o ��inr.�r� /�6r/ fv Q/V f z 7-9/ /
Phdne #:" .
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numtierendlorAddress
of theBusinessi"=°---'_'`°
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ParcelOw'fier:
// A/ISG V1°ia r�fPS iFDC LLC
Owriar'sAddiessi'"
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.Ghecli ap �.thabe I y:�t,
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New Business Chan e of use y�Chan a of Ownership ❑ Change of Name
a e v s
Business Name::':..' '
._:._':..rr .. _..... ....:.:.
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T�� VB �(� LrP ?� /Y// LGG
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Descrlptlon.Of Business:
Describe the business including use, number of employees, number of shifts, availability of parking, and any additional Into,
Previous Bueiness'on Site:
Ujy y rS r S'�a r J s
lc e/✓reSZ.
.I', IOOr. P,lad' �"." � •� -- --
Please attach sith r an erohitectdrel drawing or a sketch of the proposed business Indidating the location of uses, the
uses of rooms, the total square footage of the use, and any additional Information.
TotalSci a- Saotage.Used
for the Business:
yYsa� sF B! `f AEG �
Is the; parcel Zonbd LI; HI, or PDIP?
_
Yes No
If yes, fill out a Certified Enalneers Renorl (CER)
'kill Pup be fOOd properatlOn?,
Yes �No
If yes, provide Virginia Department of Health approval
la the Parcel on public water or private well?
E210ubllc F1 Private
If on private well, provide Virginia Department of Health approval
la the Parcel on public sewer or septic?
Ppubilc. septic
if on septic, provide Virglnla Department of Health approval
WIII'ypUb�'jhtfttlhpflp.aYiyll�W!'Sij$liatJe? —
Q✓''es ❑ No
if yes, obtain appropriate sign pennlfandlist permit#below
Wlhere" h`e:new constructorvrenovIIati's?*
yes ❑ No
If yes, obtain appropriate building permit and list penult #below
Please list any applicable Bullding Permit''#ss-
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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.
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
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