CLE202200153 Application 2022-11-29Zoning 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 North Wing
CheConesWle VA 22902
Phone 434.296 5832
Name:
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Mail Address:
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Mailing Address:
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Phone #:
114 Z
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Tax Map and Parcel
number and/or Address
of the Business:
1 j 401 Vacs} �0
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Zoning:
staff will fin out if unknown
Parcel Owner:
Chp f/ d(//k Si7/Oh Squa�G
Owner's Address: l/W?
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Check any that apply:
Li�Aew Business _' Change of Use`, Change
of ownership
Change of Name
Business Name:
Zu-s,h J*eu" Nff-
Description of Business:
Describe the business ircludirg use. number of employees. number of shifts, availatility
of parking. and any acditicnal info
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Previous Business on Site: ' r
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Floor Plan: Please attach either an architectural drawing or a sketch of the proposed business indicating the location cf uses, the
uses of roamsthe total square footage of the use.. and any additional infcrmaticr.
Total Square Footage Used
for the Business:
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Is the Parcel Zoned LI, HI, Or PDIP?
j Yes
No
If yes, fill out a Cerbfled Pnmreer's Reccrt rCER.
Will there be food preparation?
Yes
i ✓ No
If yes, provide Virginia Department of Health approval
Is the Parcel on public water or private well?
Opublic
Private
If on private well, provide Virginia Department of Health approval
Is the Parcel on public sewer or septic?
F 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
No
If yes, obtain approp ate building permit and list pe mit #below
Please list any applicable Building Permit #s:
I
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. 1 have read the conditions of approval, and I understand
them, and that I will hem.
I Signature Onnted Q/7/a..
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