HomeMy WebLinkAboutCLE200800050 Legacy Document 2013-01-03` Application for
Zoning Clearance
i f Zoning Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
Tax map and parcel: D I D(l 06 on I J f A Existing Zoning:
Parcel Owner:
Parcel Address: / lU f � pj,/ eE;7 ` City
(include suite or floor)
Zip
Contact Person (Who should we call/write concerning this project ? ?): �p�i�/j�l� ��I f
Address (19 14 _ Jh'11 �UUJV fe, _Dr */ City �`� /1 �. /� 0 11LStat� Azip
Daytime Phone Z-zFax # C___) E -mail �V 1, i 471- 1,eAr n �n' 6
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 Ab f— P
I X54 ler
`This Clearance will only be va9id 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.
Signat re of Business caner or Agent Date
Print Name
APPROVAL INFORMATION
[ ] Approved as proposed
[ l/ Approved with conditions
[ i 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.
[ ] This site compli with jhe site plan as jjf this date.
Building Official
Zoning Official
Other Official
Date o'er
Date D _
Date .
FOR OFFICE USE ONLY CLE # '21J61 e)
Pee An10Unt $ 00 Date Paid By who? _4,:3 jen. J--r' iCcjz&j Receipt fl �W Ck4 � v By: 7
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 5 /l /06Page2of4
Applicant t6 complete the following:
Do you have one of the following?
0 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.
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Zoning Tech to com
Violations: /
❑ YES F NO
If so, List:
Variance:
❑ YES [C1 NO
If so, List:
the f
f//oy
Intake to complete the following:
❑ YES 111NO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
❑ YES &ENO
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 -Nr 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
R YES ❑ NO
Is on public water and sewer?
ER YES NO
Will you Jpva
tting up a new si - f any kind? If so, obtain
proper Sign permit. �(of jj
Permit
❑ YES NO
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
❑ YES ENO
Is this for sales of Fireworks?
If so, obtain a copy of F/R permit.
Permit #
Proffers:
❑ YES [E—NO
If so, List:
SP's:
❑ YES NO
If so, List:
5/1/06 Page 3 of 4
Reviewer to complete the following:
Square footage of Use:
OYES ❑ NO
Permitted as:
Under Section:
Supplementary regulations section:
l
Parking formula: N6.
Required spaces: AAA
❑ YES ❑ NO ^ / �o '/� ¢ 7
tiia fialrl' lT 1 n oo—s L•e/ i� Ji "�• :5 • l
Inspector Name & Date:
Notes
5/1/06 Page 4 of 4