HomeMy WebLinkAboutCLE200800005 Legacy Document 2013-01-031&FF1l%,aL1V11 1V1
Zoning Clearance
❑ Zoning Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
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Existing Zoning: C�
Parcel Owner: 616 6 /� p
Parcel Address: J �e Ili n d��'i Ii City �i17\i �'Ci State V ./-A 7ipoc q`'
(include suite or floor) n
Contact Person .(Who should we call /write concerning this project ?):
Address C7 g5 DI ) ` V t 1 ✓) - City.J� ctrdsvi I If It _ State y Zip
Daytime Phone l lam' tl `1 9"0`I / Fax # I' gXSJ13 1 3 E -mail IV
Business Name /Type:
Previous Business on this site: low w� I V�iX11��
Proposed use:FtTI�lV
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 Business Ownet• WAgent Date
Print Name
AP ROVAL INFORMATION. .�
] Approved as proposed [ ] Approved with conditions Backflow Device and /or
[ ] Backilow device and /or current test data needed for 11
this site. Contact ACSA 977 -4511, x 119. Current Test Data Needed
[ ] No physical site inspection has been done for- this clearance. Therefore, it is not a determination orcompli n1re ��i X1s�l5R �StCe �,1, x 119
[ ] This site complies with the site plan as of this date.
Building Official Date 1 ( `t (%Q
Zoning Official Date
Other Official Date T�
FOR OFFICE USE ONLY CLE # 766 d06E1 G) ` yr-�-
Fee Amount $ 359C6 Date Paid 1'7 24 By who? r� l IFO� M ,� �krii Receipt it 3ck#t rf/ ►`- By: � 1 43
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 5/1/06 Page 2 oN
' Applicant to complete the following:
Do you have one of the following?
❑ YES - ❑ NO
Tax Map and Parcel Number and or;
Address of use (include unit or floor if appropriate)
❑ YES ❑ 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.
Tech to complete the
Violations:
FYES F-1 NO
If so, Lis l 2-0 0 J p
( {�
3 0 V0
Variance:
❑ YES P NO
If so, List:
Intalce to complete the following:
❑ YES [;IINO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
❑ YES 42/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
[YES ❑ NO
Ison ublic water and sewer?
Is
dN(O
Will you be uttii??��g up a new sign of any kind? If so, obtain
proper Sign per iit.�
Permit # ``
❑ YES ✓❑ 1NO
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
❑ YES JN0
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:�
Y
Reviewer to , co - mplete the following: '
Squ 4 re footage f Use:
YES ❑ 0
ermitted as:
Under Section:
Supplementary regulations section: I/LI9l
Parking formula;
Required spaces: t
❑ YES ❑ NO
Items to be verified in the field:
Inspector Name & Date:
Notes
5/1/06 Page 4 or