HomeMy WebLinkAboutCLE200800051 Legacy Document 2013-01-11Application forte➢ °`eery
Zoning Clearance
❑ Zoning Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
Tax map and parcel: y (o I o ® - 00 — 60-1-2-7 13o Existing Zoning: C-0
Parcel Owner: V6Lk-LdeVbhCje
Parcel Address: I `r 5- r,21 o r-�r ' GAS—F City C IVI LLC- State ✓ /+ Zip 27 11
(include suite or floor) 'j L-Lrr" �
Contact Person (Who should we call /write concerning this project ?):
Address /� c�bl eL)e70 1 City Civi / te,— State VA— Zip' Gz-go
Daytime Phone ( `76s' J_`�U I Fax #d ( "" % E -mail /'K� � wn.er �10
Business Name /Type:
Previous Business on this site: 54- k t pi-e V i 0
Pro. se use: Veil ( V►1 ' W 1 �V �1`�' f) rl (%> jG1
e 4-16-n YL- c &Y�
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.
Sig Z 't re o Business Owner or Agent Date
�a�..
Print Name
APPROVAL INFORMATION
[ j] Approved as proposed [ ] Approved with conditions
[�],Ba Idlow device and /or current test data needed for this site. Contact ACSA 977 -4511, x119.
4? -]'�lo 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 ll ��
Zoning Official Date � 6 $
Other Official Date "
FOR OFFICE USE ONLY CLE # a lxj9 5 f . ��`
Fee Amount $� Date Paid By who? Receipt #! / Ck# ab By: y
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 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.
of
Tech to complete the followin
Vilations:
0 YES ❑ NO
Variance:
❑ YES
If so, List:
I' NO
Intake to complete the following:
❑ YES 2ZNO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
❑ YES 2 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
10/yES ❑ NO
Is on public water and sewer?
❑ YES ❑1 /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 ❑V NO
Is this for sales of Fireworks?
If so, obtain a copy of F/R permit.
Permit #
Proffers:
❑ YES [2'NO
If so, List:
SP's: /
F-1 YES F/, ]/NO
If so, List:
5/1/06 Page 3 of
Reviewer to complete the foo owigg:
Square footage of Use: 4 ��
❑ YEV6 NO C. I ,
Permitted as: i'�!5 r co UA—b
Under Section: dz)
Supplementary regulations section: !ti
Parking formula: ( ( �L b U � a
Required spaces:
❑ YES P/ NZ
Items to be verified in the field:
Inspector Name & Date:
Notes
5/1/06 Page 4 of 4