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HomeMy WebLinkAboutCLE200800054 Legacy Document 2013-01-11Application for ZoninLy Clearance ® v ❑ Zoning Clearance = $35 PLEASE REVIEW ALL 3 SHEETS Tux map and parcel: Existing Zoning: Parcel Owner: ( `L'° LL C, _ Parcel Address: %( q `1 � t.( I ✓ id 60 �/LKA v�it�3 �,/ & State ✓% ( ZiIr22,1`L t (include suite or Libor) n 7 > /M1 Contact Per on (Who should we call /write concerning this project ?): Address e !�9 (% CD,1Cr),t_,C)xS City L!�1a./ � 'SU>�('P State V4 Zip lD� 1 Daytime Phone (/J ,��ii Fax # L� E -mail rrI /V�S i��� -� ) �C •'Z i� e /� _ :_ �^ _ •�'3'� � taa�n y �.Ciat'✓'�5�.; ��.�� �r 7'�rn ��•�'t /�� 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 ch___b.:, 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 tt a an a I urate to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by -th Signat of Busine s Owner 4r A t Date Print Name FBackiloW Device and /or Current Vest Data APPROVAL INFORMATION [e Approved as proposed [ ] Approved with conditions 977 -4511, x 119 [ ] Backflow device and /or current test data needed for this site. Contact ACSA 977- 4511,'x 119, �o physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing site plan. L 1 This site complies with the site plan as of this date. Building Official 3A, Date o' Zoning Official Date Other Official Date FOR OFFICE USE ONLY cLE # m y %� Fee Amount $ �� ..,` Date Paid h �� PBy who? Receipt il b 1]O l Ck441'A By: cc tj 1 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? ❑ YES [YN'0 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 tlian the entire structure, note the location within the structure. Zoning Tech to complete the ©AYES V ❑ NO If so, List: - 8 u Sa 5'��✓ ' J411ti C41 A Variance: ❑ YES ,❑/ NO If so, List: Intake to complete the following: ❑ YES ff"NO Is use in LI, HI or PDIP• zoning? If so, give applicant a Certified Engineer's Report (CER) packet: ❑'YES' .n 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 • A, ❑ YES 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. Permit # ❑ YES Is this for sales of Fireworks? If so, obtain a copy of F/R permit. Permit # Proffers: P "YES ❑ NO If so, List: 66 ��G�� D �C. �V SP's: ❑ YES ❑ NO If so, List: <, C /1/llL -- 'I _CA