HomeMy WebLinkAboutCLE202200151 Application 2022-11-29pr
Zoning Clearance Application
FOR OFFICE USE ONLY Clearance Numbere(t=2- _ i5 I
Fee Amount: $ 61.36 Date Paid: I I la9I.2.�2 Byjv(�'
Application fee: $59 + Technology Surcharge: $2.36
Albemarle County
Comnun9y DevebpmeM
401 Mcl A. Rd, N ft Wimp
Charloft"Wie, VA 229M
Phone 4 1.296.5833
Receipt #: I Z 0 I g(-P Check #: �20 I I By: rt 17 VI 00L Ord Th4s't
Applicant - Fill out the entire page below and return to:
Community Development 401 McIntire Rd, North Wing, Charlottesville, VA 22902
Name:
E-Mall Address:
if
Mailing Address:
'f2
Phone #:
3 K
Tax Map and Parcel
p /� 1 W o _ v t - O A - 0%90 goo Zoning:
number and/or Address
the Busines
3Y0 [�Il&l0&jawL%Ce 9rUVF Staff will fill out Ifunknown
NClbu 90AJooip
Of s:
C
A1tADfiti
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Parcel Owner:
Owners Address:
ftc� L-jm fprLEt 1 LAnl
^
Check any that apply:
New Business ❑ Change of Use ❑ Change of Ownership ❑
Change of Name
Business Name:
� Au oTitilc- A $jzrt,Vfc¢.
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:
LFloor 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: 3 `foD
ned LI, HI, or PDIP?
❑ Yes �No
If yes, fill out a Certified Engineers Report (CER)
aration?
tParcel
❑ Yes 2"No
If yes, provide Virginia Department of Health approval
!pub!llcwater or private well?
(� public ❑ Private
If on private well, provide Virginia Department of Heahh approval
sewer or septic?
2 public ❑ Septic
If on septic, provide Virginia Department of Health approval
Will you be putting up any new signage?
❑ Yes No
If yes, obtain appropriate sign permit and list permit # below
Will there be new construction or renovations?
Yes (�y,�o
❑ LJ
yes,g permit and list
If s obtain appropriate buildin 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 abi b am.
Signatur �i— Printed
Sur- ALaKiCcH-r—
Date /III(..I?.z
pF
Albemarle County
Zoning Clearance Application ` CommonMciner Development
C Oftesee, NU92
T CM1erlotlesWlle, VA 22982
rFAGIN��' Phone 634.296.5832
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,
clearance number provided by Staff or business name
to nj u'[IA! C.l= t a u ysr the owner
Name o andowner on record
of Tax Map and Parcel Number (.96 Wr) , r7l . OA - 04a a by either delivering a
TMP number o/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)
Ly' Hand delivering a copy of the application to the owner identified above on
Date
❑ 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 d�ermiq" this inforation if needed)
Signature of Applicant
Applicant Name Printed SUG -4. LfZ Ik'C KI—
Date /1 f Ia/, / 2 v
3
For Albemarle County Staff Review Only
Proposed Use: Permitted:
❑ Yes ❑ No
Permitted by Section: Supplementary Regulations:
Applicable Special Use Permit (Sp):
Applicable Razonings (ZMA):
Applicable Site Plans (SDP):
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: Defined by. ❑Site Plan ❑ Zoning Ordinance ❑ CoD ❑Existing
Total Square Footage of the Use:
Required number of perking spaces:
Associated Clearances:
Variances:
Is a site Inspection necessary?: I ❑ Yes ❑ No
Site Inspection on (date). IT. e:....a.....
Conditions of Approval: I Additional conditions of approval apply to Fireworks and Christmas Trees
Approval Information
❑ Approved as proposed ❑ Approved with conditions j ] Denied
❑ Bacliflow 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:
FBuild!ng
Other Official
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Phone: 434.296.5832 Fax: 434.972.4126
4