HomeMy WebLinkAboutCLE200800006 Legacy Document 2013-01-03Application for
Zoning C"ance
Zoning Clearance = $35
PLEASE REVIEW ALL 3 SHEETS q Z007— / 5
Tax map and parcel: NV AD �7 °� {' r a b Existing Zoning:
1
Parcel Owner:
L
Parcel Address: 401 - PW4.o..°�a'_S00 � City C >ay -4e.ra� ?0 State Vim Zip zj
(include suite or floor)
Contact Person (Who should we call /write concerning this project ?): iLo'nTy\ f } CL,C i, oy? lc�
Address i C ' � ,+ „ ;,., j 93 .. City s� `�, State VOL Zip ?'Z
a � �
Daytime Phone 3I j 5 � ` .��ata'�.` Fax # ( 1'D' °I �t ` ZAG) S t E -mail
Business Name /Type:
Previous Business on this site: ? >Ja ..YY.. t
ly
Proposed use: --'-?- -� > — d �`T fi 1`d l 'S -�^�� Pe, e-
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
abid �y them.
dsiix/u�- K10,
Signature of Business Owner or Agent Date
,-I fy- u\ C--1 1 a CQ � k5,A p
Print Name
APPROVAL INFORMATION
[ ] Approved as proposed [Approved with conditions
] Backflow device and /or current test data needed for this site. Contact ACSA 977 -4511, x119.
] No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing site plan.
is site coiy} ies wi4the site plan as o i da
A
/ U` �� 0 w 4..5 ca N►ve -u=� �s OZr -tl f4 ,� .RAJ a
Building Official .�`� \c Date b�
Zoning Official Date t
Otlier Official Date 1 0
— ,ter / b!�
FOR OFFICE USE ONLY _ g CLE # �✓�c SO ��• %1
Fee Amount $ Jr►n� Date Paid 171 y who? Receipt # b O k S s 1 By:
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 of 4
Applicant to complete the following:
Do you have one of the following?
PllYES ❑ NO
Tax Map and Parcel Number and or;
Address of use (include unit or floor if appropriate)
W0 E Y S ❑ NO
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.
op�j
Tech to co
Violations:
❑ YES 0 NO
If so, List:
Variance:
❑ YES VNO
If so, List:
the foll
Intake to complete the following:
❑ YES NO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet. '
El YES O
Will there be food preparation?
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from
Health De t FAX DATE /4'd'6
YES ❑ NO J
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 0
Is on public water and sewer?
[/YES ❑ NO
Will you be putting up a new. sign of any kind? If so, obtain
proper Sign permit.
Permit #
❑ YES ❑ NO
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
❑ YES Lam" N v
Is this for sales of Fireworks?
If so, obtain a copy of F/R permit.
Permit #
Co YES ■ NO
If so, List:
�4 11: ► .
!� "V
SP's:
❑ YES [O"'NO
If so, List:
Reviewer to complete the following�J��
n footage of Use; S ❑ C
Permitted as:
Under Section: M 'd\' l
Supplementary regulations section: W
Parking formula: 00 1 / I/
Required spaces: ywyI
❑ YES V N
Items to be verified in the field:
Inspector Name & Date:
Notes
5/1/06 Page 4 of