HomeMy WebLinkAboutCLE200800214 Legacy Document 2013-03-18Application for Zoning Clearance'-1 =a�: -�
OFFICE USE ONLY
Zoning Clearance = $35 CLE # lr(
PLEASE REVIEW ALL 3 SHEETS Check # (7 2 Date:
Receipt # .,IZ (CIO it Staff. Wig
PARCEL INFORMATION
Tax Map and Parcel: 07800 —0000 — 03 /C67 Existing Zoning PPI-14i
Parcel Owner: ro r o&itdma
Parcel Address: 4 ' er' LT So f..� City ( .Np'4o sv, l�� State U Zip
- -- - - -- - -- - - -- (include suite or floor) S- ifG �8---------------------------------------------------
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PRIMARY CONTACT r�
Who should we call /write concerning this project? IS�2 cT�r►eS ' f g �/ I %O✓1/ o�P f71f'S
Address: 901X 7� City djpv/a (1G State Zip 900
Office Phone: !7,13—g900 Cell x #y3y!- X97- 3 755E-mail' r�'ef,eoM
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PROJECT INFORMATION al
Business Name/Type:
Previous Business on this site:
Proposed use: Qml�i•� DiC cr v '
Circle (if applicable): Fireworks / Christmas Tree
SEE CONDITIONS OF APPROVAL IF THE CLEARANCE IS FOR FIREWORK OR CHRISTMAS TREE SALES (Sheet 1)
*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 y knowledge. I have ad the conditions of approval, and I //understand them, and that I will abide by them.
Signature Printed Sh., Z7 , �
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AP VAL INFORMATION
Approved as proposed [ ] Approved with conditions
[ ] 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 complies with the site plan as of this date.
IF
Building Official Date
Zoning Official Date D
Other Official Date
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County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 10114105 Page 2 of 4
Applicant to complete the following:
MIN
o you have one of the following?
Tax Map and Parcel Number and or;
Address of use (include unit or floor if appropriate;
/N
o 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.
: oning Tech to
Viol ons:
Y /
If so, List:
Var' ce:
Y/,F
If so List:
the
Intake to complete the following:
Y
Is u I, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y /
Will" ere 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
YIN
Is parcel on ' ate 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
/ N
s on public water and sewer?
YIN
Will you be putti g up a new sign of any kind? I.f so, obtain
proper Sign perm t.
Permit #
YIN
Will there be any
If so, obtain the p c
Permit #
Is/
Is th� or sales of R
If so, obtain a copy
Permit #
construction or renovations?
• Permit.
F/R permit.
V N
If so, List:
1
b:4n�
'YJ / N
� f so, I�ist:
10114105 Page 3 of 4
Reviewer to complete the following1,9_00
Square footage of Use:
M N
ermitted as: C�
Under Section:
Supplementary regulations section: ' �,1 d
Parking formula: G � 0 `tom
Required spaces:�-
Y/N
Items to be verified in the field:
Inspector Name & Date:
I Notes
1 V/ 1'7/ VJ x ar, + - V l '