HomeMy WebLinkAboutCLE200800045 Legacy Document 2013-01-03Application for
Zoning Clearance
❑ Zoning Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
Tax map and parcel: MI fto - `tea ' i e Existing
Parcel Owner:
Parcel Address:
(include'suite or floor)
�oe n�Be�
I %RCIN"�
City ' 0 )@-- Zip 2Z
Contact Person (Who should we call /write concerning this project ?):
Address S 4 M . ;-" , n a 14- �+ l i-�e.: d b City State 114- Zip
Daytime Phone Pqt — 2 Fax # ( d:7/ 4� g E-mail
Business Name /Type:
Previous Business on this site:
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
abide by them.
- -- 2, '7{
Sigt ature of Business Own r or Agent Date
Print Name
VAL INFORMATION
,ed as proposed
[ ] Approved with conditions
[ -] Backtlow device and /or current test data needed for this site. Contact ACSA 977 -4511, x119.
o 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 Q ;1
Zoning Official Date � os _
Other Official Date
FOR OFFI JJ NLY C�/ # ��.��� r
Fee Amount � ��— Date Paid By who? [ �E.ti�l r- Receipt # Ck #� By
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 5/1/05 Page 2 of 4
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 f
- -�' -,. ✓L aLx-D
Vi tions:
YES ❑ NO
If so,ListtM — ;n 4-(I�
Variance:
❑ YES Pf"NO
If so, List:
Intake to complete the following:
❑ YES O
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
❑ YES �❑i 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 ,Q 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
Z""
.0 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 ❑ O /
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
❑ YES ❑/ NO
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 ❑VNO
If so, List:
5/1/06 Page 3 of 4
Reviewer to complete the followlyb
Square footage f Use:
❑ YES ❑ NO� �
Permitted as: 75(f S0
Under Section: k , a . t fib- 2'`
Supplementary regulations section:
Parking formula:
Required spaces:
❑ YES ❑ NO
Items to be verified in the field:
Inspector Name & Date:
Notes
5/1/06 Page 4 of 4