HomeMy WebLinkAboutCLE200800022 Legacy Document 2013-01-03Application for
Zoning Clearance
Zoning Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
Tax map and parcel: 16 -1 WA Existing Zoning: •I 1 c
I '
Parcel Owner: 1 D3 b + `- P()n-IOD6 �D Yi Vt �L��1'� ', �("bad EJ LEI I-h.� 4 ,\ �+rt � Acc
Parcel Address: I03 6011.'1'C 1 PaATJ S I/I�i& CityrYad �T noj IE State VA Zip Z2q
(include suite or floor) 6W Lf- 102- I^ q 1 / Land n
Contact Person (Who should we call/write concerning this project ?): A Vt2 , I,",'Id �O V 1 ��f �.i) lid L�..l.nd l .I mfflmd
Address M �i yuhmd Dave. City P, CLdme -w he -State _VA Zip 2z nI I
DaytimePhone(A Fax #d3 ZQIo- .551Q E -mail
Business Name/Type: ji Pecovelfl ��un krn-� LLG dibi.A A U 2114r)P Pj inrCG
Previous Business on this site: 1"far/lowe- PCWef i'
Proposed use:
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 bjy them.
J
Signatur ` of Business Owner or Agent Date
S%L PHL`W /K
Print Name
APPROVAL INFORMATION
[v1 Approved as proposed [ ] Approved with conditions
] Backflow device and /or current test data needed for this site. Contact ACSA 977 -4511, 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
Zoning Official Date
Other Official Date
FOR OFFICE USE ONLY I I e CLE # --I—
Fee Amount $ 00 Date Paid a� D �+ By who? Receipt # � 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 Page2 of4
Applicant to complete the following:
Do you have one of the following?
[2'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.
Zoning Tech
Violations:
❑ YES [Z
If so, List:
i
complete the following:
NO
Variance:
❑ YES U NO
If so, List:
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.
❑ 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 [9/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 #
❑ YES ❑ NO
Will there be any new construction or renovations?
If so, obtain the proper Permit. L
Permit# 2-CO R / (a(
❑ YES [u]' ]O
Is this for sales of Fireworks?
If so, obtain a copy of F/R permit.
Permit #
Proffers:
F-1 YES /_
If so, List:
SP's:
❑ YES 0-'NO
If so, List:
5/1/06 Page 3 of 4
Reviewer to complete the following: 3�0
Square footage of Use:
YES ❑ NO O r ;W
Permitted as: � rr __
Under Section: 2'� a•� �J
Supplementary regulations section: OL.
Parking formula: l°t6 Vj
Required spaces:
YES ❑ NO
Inspector Name & Date::
m—& Q� %0/V
Notes W ��� � � � Vn,� ""`^
�'�
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5/1/06 Page 4 of 4