HomeMy WebLinkAboutCLE200800014 Legacy Document 2013-01-03Application for
Zoning Clearance
21zoning Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
Tax map and parcel: 96- ((p /-t Existing Zoning: H L'
Parcel Owner: IN 3ou4h 8�p6
D Ki y� end I is �-L -, Ch(d r-3 W, � LzA , 1 iACE
Parcel Address: 103 ,6alh Pu -nWini D rive, City C aI ew k State VQ
Zip 229 L
(include suite or floor)
Contact Person (Who should we call/write concerning this project?): L�� , Q,f 'i-( --1 @ VI [no `Land N`,m ,l,n q
Address lq5 II I ye Yhmd Drive City Our/ Phvl Ile State V -Zip
Daytime Phone" q T1 R I A I Fax # 4A _Zq b h If) E -mail
BusinessName/Type: konew ] Shaln BudL affiC
Previous Business on this site: dn,di m - Ala(, -hm
Proposed use: Profe_s3 aml I of-ha- —Ohow roorn
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 y them.
2, , )��uay 2-2 2.,Vd-%?
Signature of Business Owner o gent Date
Sim =rd _W )1R. /R �Z
Print Name
AP OVAL INFORMATION "a��:rt"lo w "ewice anct /or
[0 Ap roved as proposed [ ] Approved with conditions Current Test Data Needed
Contact ACSA 977 -4511, x 119
ackflow device and /or current test data needed for this site. Contact ACSA 977 -451 1, x 119.
[ 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. (IbLZ I av
Zoning Official _ ` Date _
Other Official Date
FOR OFFICE USE ONLY �_' �� �j CLE # s �-
Fee Amount $ Date Paid J 1 /L/V �y who? /(f f l Receipt #(J �J Ck# By:
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 of4
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.
F
Zoning Tech to com
Violations:
❑ YES NO
If so, List:
Variance:
❑ YES [P NO
If so, List:
ete the following:
Intake to complete the following:
❑ YES ZNO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
❑ YES 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 E:�/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
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 #
[o"�YES ❑ NO
Will there be any new construction or renovations?
If obtain pro e J C—
Perr mit #
❑ YES NO
Is this for sales of Fireworks?
If so, obtain a copy of F/R permit.
Permit #
Proffers:
❑ YES 42 "NO
If so, List:
SP's:
❑ YES 0 NO
If so, List:
5/1/06 Page 3 of
Reviewer to complete the following:
Square footage of Use:
[(V YES ❑ NO
Permitted as: Y'e,'iGL • ` G-�I't
Under Section: A 9- 1 Cif
Supplementary regulations section:
Parking formula:
Required spaces:
❑ YES ❑✓(NO
Items to be verified in the field:
M. 6t
Inspector Name & Date:
Notes
511106 Page 4 of4