HomeMy WebLinkAboutCLE200700101 Legacy Document 2013-12-12Application for Zoning Clearance
X
0 Zoning Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
PARCEL INFORMATION
Tax Map and Parcel: `'f 5 —
Parcel Owner:
iu� .
OFFICE USE ONLY r
CLE# Z00-7— %O
Check # 17-91 Date: 4--/C/-, -O 7
Receipt # 6_516(o Staff:
51 Ca 9 Z H �.0 Cc r'Yl
Existing Zoning
- 191001 S A I
Parcel Address: 76 J Yl �`�� City CYUI) �,State Zip pi9t��
- -- -- (include s�__te_or floor
IN FOR MAT ION
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APPLICANT �� /� 9
Who should we call /write concerning this project? e_ LQ( 1 X111,
IDS
Address: , _ c �(; ff City State Zip Q"
f
A.
Office Phone: ( (as Cell -0�fC_ Faz # E -mail e' A5, Cd�f
----------------------------------------------------------------------------------------------- - - - - -- ------------------------------------------
PRIMARY CONTACT AA 11 r
Business Name /Type: A11Y1GY lean �ibW1[s� 16VlCp U��S i i, 1 MT
Previous Business on this site:
use:
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 a best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed L e— � I A-<;
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APPROVAL INFORMATION
[ ] Approved as proposed [li] Approved with conditions
[ ] No physical site inspection has been done for this clearance.
site plan.
[ ] This site complies with toe site plan as of this date. i
Therefore, it is not a determination of compliance with the existing
S - I
Building Official Date ,, _
Zoning Official Date �� �� 07
Other Official ,fig �r �f�'1°rly'a 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
Applicant to complete the following:
(Y }' N
o you have one of the following?
Tax Map and Parcel Number and or;
Address of use (include unit or floor if appropriate;
6)1 N
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.
coning Tech to
Violations:
Y/N
If so, List:
the following:
9/28/05 Page 2 of 4
Intake to complete the following:
Y /6N
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
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
Y / T
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
N
s on public water and sewer?
Y /PN I
Wil you be putting up a new sign of any kind? If so, obtain
proper Sign permit.
Permit #
Y /
Will ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
YY N
this for sales of Fireworks?
If so, obtain a copy of F/R pej
Permit # C)prTchrRO
Proffers:
Y/N
If so, List:
Variance: SP's:
Y/N Y/N
If so, List: If so, List:
Reviewer to complete the following:
Square footage of Use:
Y/N
Permitted as:
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces:
Y/N
Items to be verified in the field:
Inspector Name & Date:
Notes
9%225 /U5 Page 3 of 4
3/26 /US Page 4 of 4
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www.ACFireRescue. urg
FIRE PREVENTION PERMIT APPLICATION
APPLICATION DATE: 1 fr C.
DATE OF ISSUE: t-u (jU 0 ^,�
APPLICANT NAME: N I� f i (9, ` �'� r,,,- K-5
AFTER HOURS TELEPHONE: )
ADDRESS: ! c) � ,-5 C, L,4s4 t' j , t — (ree -4
PERMIT NUMBER:
0 o-7 TZ0
EXPIRATION DATE: pr f 0 b /
DAYTIME TELEPHONE: "3 k-,)` /) �/'0 6kL
MOBILE TELEPHONE: "Ll
CITY /ZIP CODE: = r� , Vex
PROPERTY OWNER: LA ) o 1 rr d r 1 - TELEPHONE:
ADDRESS: CITY /STATE /ZIP CODE:
TYPE &EXTENT OF ACTIVITY: r S ec —1 . ✓4 � � R 1 ry r I
LOCATION OF THE ACTIVITY: " J ?f1 I f Tt' r1 t} C I 1 I 3 r)'-'A
(Use Tax Map, ADC Mapbook, or Specific Directions
to Site)
❑
APPROVED ❑ NOT APPROVED WITH CONDITIONS
CONDITIONS: ❑ Fire must be attended at all times.
❑ Adequate means of extinguishment must be on site at all times.
XMust comply with all applicable Federal, State, and Local laws, rules, regulations, codes, and ordinances.
❑ Must maintain a minimum of 50' clearance around pile at all times.
❑ 15 February - 30 April: Open burning permitted between 1600 Hours (4:OOPM) and 0000 Hours (Midnight) only.
❑ Must correct any Code violations found.
El
El
STATEMENT OF RESPONSIBILITY
I hereby acknowledge that the information contained herein, and declare that it be true and correct, to the best of my knowledge and belief.
Further, I am the owner /operator, or a duly authorized agent, acting on behalf of the owner, for all activities at the above referenced property
or location. As such, I hereby agree to comply fully with all requirements in the Albemarle County Fire Prevention Code governing the
operation I wish to conduct. If there has been any false statement or misrepresentation as to the material fact ip�. -the application, data, or
lI plans on which the permit or approval was based, the Fire Official inay rev(o /fLJ�Q' this pern it.
I C " V
OWNER /AGENT SIGNATURE DATE ; FIRE PREVENTION INSPECTOR SIGNATURE
White -Office
Yellow - Applicant
OFFICE USE
/
Associated Fees: $ / 0 [) , Z) j
Check # I'2'2-Q } Cash $
Receipt # u U t_ !