HomeMy WebLinkAboutCLE200800118 Legacy Document 2013-01-16Application for
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Zoning Clearance`:
Zoning Clearance= w?�
PLE SE REVIEW ALL 3 SHEETS
Tax map and parcel: .O,)&)0a 000 (,2Q I Existing Zoning: lam.
Parcel Owner:
Parcel Address: 3-155 Go. 1 QVbpl Iz. IN City 0 V) f��n.Sf�1�l ptate Q14 _Zip)
(include suite or floor) Sum 10 2 ~
Contact Person (Who should we call/write concerning this project ?): ► ► l -F �:[ t t LL t CLVI
q � �` 1 i'
Address l �'1�[P/l ` Fb 1�UX 1 City
—1 /(A. VAPz [ L(QState y� Zip r9a9
Daytime Phone p1& Fax # tl.J [1 aC] (� t�rj (jj E -mail
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.
1 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.
Signature of B sines caner or Agent Date
Print Name
AP ,KOVAL INFORMATION
( Approved as proposed [ ] Approved with conditions
[ j Backflow device and /or current test data needed for this site. Contact ACSA 977 -4511, x 119.
[ ] physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing site plan.
[ s sit ompIies wi the site plan as of this date.
r
Building Official Date
Zoning Official Date 0
Other Official Date
FOR OFFIC USE_ONLY � CLE # /�
Fee Amount '9z Date Paid ,ci Biy who? iV "/Z-✓ Receipt # Ck# L 061 By
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 5/I/06 Paget of 4
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Applicant to complete the following:
7 Do ou have one of the following?
YES ❑ NO
Tax Map and Parcel Number and or;
7 Add S 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; 9, a...q 5 ($t,t,.tty —)
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.
Q 2 IOvL P �ao"
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Zoning Tech to com
Violations:
❑ YES []/No
If so, List:
Variance:
❑ YES [�/NO
If so, List:
the following:
Intake to complete the following:
❑ YES [:11NO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
❑ YES L f 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 []'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 wate and sewer?
❑ YES dNO
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 111N0
Is this for sales of Fireworks?
If so, obtain a copy of F/R permit.
Permit #
Cn / q/— 3r
Proffers:
❑ YES [O'NO
If so, List:
SP's:
❑ YES NO
If so, List:
5/1/06 Page 3 of 4
Reviewer to complete the followin�
Square f age of Use:
YES ❑ NO b �� D
Permitted as: wl M CA
Under Section: _ z'.
Supplementary regulations section: _ VL Gt
Parking formula: U �
Required spaces: � f✓
N otes
5/1/06 Page oN