HomeMy WebLinkAboutCLE200900180 Legacy Document 2012-10-15Application for
Zoning Clearance
Zoning Clearance = $35
PLEI E REVIEW ALL 3 SHEETS
Tax map and parcel: a o Existing Zoning: C. I
I � /MIN�N
Parcel Owner: 75e.P,13 'V[_t jM42n
Parcel Address: X/e l EO S4atn city 1 %ems r�e S(Jel ��� State ie 6 Zip 8�9�
uY&O .ryy (inchkde or floor)
Contact Person (Who should we call /write concerning this project ?): S0020:4%4 - iOQC — gn�_1,0 I eayt -n
Address t Cpl 2r)e i,S4oRS ZZVj,, -TVy sl .fe 7 City C,h./ % y"If•P State VO Zip $�O�
Daytime Phone aA �7_ Z-O j ,�S' I+ax # (_)
Business Name /Type:
Previous Business on this site: — ^_)'6J�
Proposed use: /�s ��r' 'n [.ya �S YI'1�r �. W d_%L k e
E -mail
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.
Si ature of Business Owner or Agent Date
Print ame
APB VAL INFORMATION
[ I Approved as proposed
[ ] Approved with conditions
Backflow device and /or current test data needed for this site. Contact ACSA 977 -4511, xl 19,
] 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,
Building Official" <— Date ( 0 t �r
Zoning Official Date j v
Other Official Date
FOR OFFICE USE ONLY ,,llpp CLE #
Fee Amount $ 0v Datc Paid) t�0� V -1By who? - - /t; +' , Receipt 1l f) �/ Ck# By: 1
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296• -5532 Fax: (434) 972 -4126 5/1/06 Page 2 of4
- AppliQ',ant to complete the following:
Do you have one ofthe following?
❑ YES ❑ NO
Tax Map and Parcel Number and or;
Address of use (include unit or floor if appropriate)
❑ YES �2/N0
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.
Q d C1 sto cl- C- .vii- °s C
, oning Tech to c
Violations:
❑ YES ❑ NO
If so, List:
Variance:
❑ YES ❑ NO
If so, List:
lete the following:
.—C-90 / the following:
❑ YES' &�I'NO
Is use in LI, HI'or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
❑
YES 00
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
�S [I NO
1s on public water and sewer?
❑ YES `1❑ NO
Will you be putting up a new sign of any kind? If so, obtain
proper Sign permit.
Permit #
❑ YES 0
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
❑ YES NO
Is this for sales of Fireworks?
If so, obtain a copy of F/R permit.
Permit #
Proffers:
❑ YES ❑ NO
If so, List:
SP's:
❑ YES ❑ NO
If so, List: