HomeMy WebLinkAboutCLE200900010 Legacy Document 2012-08-22Application for
Zoning CVrance ,N(r
. 'Zoning Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
Tax map and parcel: T y/%C'< 9f lA sr.P1 / h q Existing Zoning: /
Parcel Owner: ,Y�o (tl ogS /1�0j1 / /,"I' / /y , ��, f
Parcel Address: K4 Alawk 5� ((yep& .�t /* ��G7 City ��al /Ci'4d�'P✓) State //� Zip �•Z �� /
(include suite or floor)
Contact Person (Who should we call /write concernin this project ?): i
Address L City �(/ •/ State Zip ��
Daytime Phone ( LJ - ? Fax it E -mail 1�2XOxlje
Business Name /Type: Aiz;;
%lf
Previous Business on this site: /l% i(%
Proposed use:
SEE CONDITIONS OF APPROVAL IF THE CLEARANCE IS FOR FIREWORK OR CHRISTMAS TREE SALES (Sheet 1)
Circle (if applicable): Fireworks / Christmas Tree
*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 of B siness Owner r A n Date
/` cr
Print Name
APPROVAL INFORMATION
VJ Approved as proposed
[ ] Approved with conditions
[ ] Backflow device and /or current test data needed for this site. Contact ACSA 977 -4511, x] 19.
o physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing site plan.
] This sitieicomplies�with the site plan as of this date.
Building Official Date [,-a `t
Zoning Official Date o
Other Official Date
FOR OFFICE USE ONLY CLE # Z009 /Q
Pee Amount $1aC5P Date Paid d �L'7-0 9By who? /!R IBC Receipt # 737407 Ck# By:
f—
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434).972-4126 5/l/06 Page 2 of4
Applicant to complete the following:
Do you have one of the following?
[j/iES ❑ NO
Tax Map and Parcel Number and or;
Address of use (include unit or floor if appropriate)
�ES ❑ NO
Do you have a Floor Plan (sketch or an architectural drawing) that
includes the following, and if so please provide it with the
application?
The total square footage of the use and /or;
The square footage of each room or area of use;
Use of each room or area
If using less than the entire structure, note the location within the
structure.
Zoning Tech to complete the following:
Violations:
❑ YES
If so, List:
V 0
Variance:
❑ YES
If so, List:
ONO
lnl:'aKC LU 1:U111111GLC LIM 1v11vrr1ur,.
❑ YES ❑ NO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
❑ YES 2r NO
Will there be food preparation?
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from
Health Dept. FAX DATE
❑ YES ❑'NO
Is parcel on private well and septic?
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from
Health Dept. FAX DATE
Z YES ❑ NO
Is on public water and sewer?
❑ YES D'NO
Will you be putting up a new sign of any kind? If so, obtain
proper Sign permit.
Permit #
❑ YES ZNO
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
❑ YES [2" NO
Is this for sales of Fireworks?
If so, obtain a copy of F/R permit.
Permit #
Proffers:
❑ YES 5;KNO
If so, List:
SP's:
❑ YES [KNO
If so, List:
5/1/06 Page 3 of
u Reviewer to complete the following: 1
Square footage of Use: l
F�KYES ❑ NO r
Permitted as: OA 6 c,
Under Section:
I (
Supplementary regulations section: '`I Cl
Parking formula: Sr Z dC% I
Required spaces:
❑ YES ❑ NO
Items to be verified in the field:
Inspector Name & Date:
Notes
5/1/06 Page 4 of 4