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Albemarle County
Zoning Clearance Application 401 Manta ReeNoM wing
GhatlofiesWlle, VA 22902
Phone 434.296.5832
FOR OFFICE USE ONLY Clearance NumberktzoZ?),-00cr�
Fee Amount: $ 61.36 Date Paid: Il0 W3 By: D w
Application fee: $59 +Technology Surcharge: $2.36
Receipt #: I1XD'1L( 0 Check #a5DI By: ,t
Applicant - Fill out the entire page below and return to:
Community Development 401 McIntire Rd, North Wing, Charlottesville, VA 22902
Name:
Lincoln
E-Mail Address:
Citar�t04's"Go-rs6%.It
Mailing Address:
I t $SS % hok %?b�j Sg17L 102
Phone #:
3q IIS3- 'Be B'A
Tax Map and Parcel
number and/or Address
of the Business:
IZoning
04SCO-01-00.00/00
t 5 Sevetiu#k a�k..i4t lei„
Staff will fill out ifmnown
14-44 HC-Highway
Commercial
Parcel Owner:
��
0. ��h LLC
Owner's Address:
-70 1h %4SId4 Lanz v
2
Check any that apply:
❑ New Business &ChangeofUse Change ofOwnership ❑ Change of Name
Business Name:
eocK Sh"dcwrt Ch0►A D 1 W V- 11 C LI.C.
Description of Business:
Describe the business induding use, number of employees, number of shifts, availability of parking, and any additional Info.
non-00"iUC} b0Wh4j PrO~ Ar O&WIC w17% rl*hschs A/e
81-50-5 m-F (4'—1
SoMIPmviroft*h*jboo4 r- i�di t� 3?lundr
Previous Business on Site:
C �., dt��9 AeA.
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:
21 ��
Is the Parcel Zoned LI, HI, or PDIP?
❑ Yes ❑ No If yes, fill out a Certified Engineer's Report (CER)
Will there be food preparation?
❑ Yes )04o If yes, provide Virginia Department of Health approval
Is the Parcel on public water or private well?
Public 11Private If on private well, provide Virginia Department of Health approval
Is the Parcel on public sewer or septic?
Public ❑ Septic If on septic, provide Virginia Department of Health approval
Will you be putting up any new signage?
D< Yes No If yes, obt in approp ate sign permit and list permit # below
Will there be new construction or renovations?
❑ Yes X No If yes, obtain appropriate building permit and list permit # below
Please list any applicable Building Permit #s:
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
Signature Printed SQrQ� L.��:�QO1h
Date 10 2
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Zoning Clearance Application �Albemarle County
Community development
Te 401 McIntire Rd, ChWing
CharlottesNlle, VA 229 22902
�A Phone 434.296 5832
Applicant - If you are not the land owner, please fill out the entire page below confirming that you have either
informed or are going to inform the owner of your zoning clearance application.
CERTIFICATION THAT NOTICE OF THE APPLICATION HAS BEEN
PROVIDED TO THE LANDOWNER
I certify that I will provide (or have provided) notice of this clearance application,
CLE20235 RO K SigOo �ow�rigC.4lo+r�0'sv�IIC U•C
clearance number frovided by Stallf or business name
to R M�a &DA L-Lit—'a the owner
Name of landowner on record
of Tax Map and Parcel Number I0KScii -0m -001 00 by either delivering a
TMP number of property
copy of the application to them in person or by sending them a copy of the application by
mail. (Please check one of the following below)
Hand delivering a copy of the application to the owner identified above on
Date 01I0412023
❑ Mailing a copy of the application to the owner identified above on
Date
to the following address:
(Written notice to the owner and last known address on our record books will satisfy this
requirement. Please see staff for help determining this information if needed)
Signature of Applicant
Applicant Name Printed
Date
3
For Albemarle County Staff Review Only
Proposed Use:
Indoor Athletic Facility
Permitted:
S/Yes ❑ No
Permitted by Section:
Sec. 24.2.1(42)
Supplementary Regulations:
Applicable Special Use Permit (Sp):
N/A
Applicable Rezonings (ZMA):
N/A
Applicable Site Plans (SDP):
SDP2003-83
Parking:
If there is an approved site plan associated with the parcel, the parking requirements will be defined by the SDP. Some
parking requirements are determined by a ZMA or by an approved Code of Development.
Parking Formula:
1/125 usable rec. area
Defined by:
[]site Plan SAloning Ordinance ❑ Coo ❑Existing
Total Square Footage of the Use:
2,500sf (1,381 sf used for rec. activity)
Required number of parking spaces:
11 spaces required (90 provided per SDP2003-83)
Associated Clearances:
CLE2018-5, 2017-249, 2016-68, 215-130, etc.
Variances:
N/A
Violations:
N/A
Is a site inspection necessary?:
❑ Yes S/No
Site Inspection on (date):
To Confirm:
Notes:
Conditions of Approval:
Additional conditions of approval apply to Fireworks and Christmas Trees
Approval Information
V Approved as proposed ❑ Approved with conditions ❑ Denied
❑ Backf low prevention device and/or current test data needed for this site. Contact ACSA, 434.977.4511 ext. 117
❑ No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance
with the existing site plan.
❑ This site complies with the site plan as of this date.
Conditions:
Additional Notes:
Building Official No Objection Date 03/23/2023
Zoning Official -- Date 03/24/2023
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Phone: 434.296.5832 Fax: 434.972.4126 4
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Entrance
119 sq ft 7'5"
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H�YM Ball w BalMpom
Slop so*
Door to
upstairs
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21'9"
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1262 sq ft
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Total Square Footage: 2,500 sq ft
Usable space: 1,381 sq ft =1,262 sq ft+119 sq ft
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