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HomeMy WebLinkAboutCLE200800016 Legacy Document 2013-01-03Application for Zoning Clearance ❑ Zoning Clearance = $35 PLEASE REVIEW ALL 3 SHEETS Tax map and parcel: \ M.4,,41 S ✓� n / V ?Existing Zoning: 6C:-d1At 'i 7 L-- Ck J y- Parcel Owner: ©l�- ,lr oe Parcel Address: / i.�� ? IC,i D !�-d (tir'� City me P (include suite or floor) � Contact Person (Who should we call /write concerning this project ?): C i / Ji) A-6- Address O l ? Cou Yl i `(t 4& ti L- F_f2ity °f ? X 1 &Rd Ji✓ o I/ Zip Z �l Daytime Phone `jr / 2— 7 F �) E-mail �✓L� (�%' Business Name /Type: `` A Previous Business on this site: l Z t U L.- ' � e- ��- Ld Proposed use: l.► D () 'T C> yr iy ) 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. z %� "va 6,P SS g ature of Business Owner or gent Date Print Name APPROVAL INFORMATION [J/Approved as proposed [ ]Approved with conditions, Current Test Data Needed Contact ACSA 977 -4511, x 119 [ -IrBacictlow device and /or current test data needed for this site. Contact ACSA 977 -45111 x119. [ ] No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing site plan V This site complies with the site plan as of this date. Building Official Date Zoning Official i p Date Other Official — W Date FOR OFFICE USE ONLY CLE # Q bb!9060 f 4 , q Fee Amount $ 7i Date Paid . a3' `� y who? i. f5 U l"1'� _ Receipt # 6 /_� _Ckil ©� 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 zApplicant to complete the following: Do you have one of the following? 2/YES ❑ NO Tax Map and Parcel Number and or; Addres 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: Variance: ❑ YES If so, List: Intake to complete the following: ❑ YES ©VNO Is use in LI, HI or PDIP zoning? Engineer's Report (CER) packet. ❑ YES [ /NO If so, give applicant a Certified Will there be food preparation? If so, give applicant a Health Department form. Zoning review can not begin until we receive approval fi•om Health Dept. FAX DATE ❑ YES V,., I4O 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 U,IES ❑ NO Is on public water and sewer? ❑ YES F-,--] NO Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # ❑ YES ONO Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # ❑ YES 0 NO Is this for sales of Fireworks? If so, obtain a copy of F/R permit. Permit # Proffers: ❑ YES F-1-140 If so, List: SP's: ❑ YES NO If so, List: 5/1/06 Page 3 of iReviewCr to complete the following: Squarefoota_ fUse: - ----�— Q YES ❑ NO - �,c)l� CU -6 `C j/ Permitted a :�' �O ' Under Section: b d 2 �1 Supplementary regulations section: Parking formula: Required spaces: DYES ❑ NO Items to be verified in the field: Inspector Name & Date: Notes 5/1/06 Page.4 of 4