HomeMy WebLinkAboutCLE200700129 Application2
Application for Zoning Clearance �� m
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OFFICE USE ONLY
Zoning Clearance = $35 CLE # -:2-00 -7
PLEASE REVIEW ALL 3 SHEETS Check # 1 Z. D2, Date: -- 1, 17
Receipt# Staff: )
PARCEL INFORMATION
Tax Map and Parcel: 0 ( p % LQ0 n- O3 -03 •- CQ J X� 0 Existing Zoning � � ��Yl /Y-)
Parcel Owner: Li 1VCta-
Parcel Address:) 9 13 nm MOnM" ch a•°'zQ 0 State Zip
(include suite or floor)
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APPLICANT INFORMATION
Who should we call/write concerning this project? L 0 \tc�
Address : �l ��City -Q�6 L State Zip
`� 15 7
Office Phone: 7( �"]) L(9 %- S e 99 Cell # Fax # 727- O 0 0D E -mail
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PRIMARY CONTAC
Business Name /Type:
Previous Business on this site:
Proposed use:
l' _ \ A
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 t t 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 the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
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Signature Printed @"O(q 40lIAL
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Ar71,OVAL RMATIO
Zroved as proposed [ ]Approved with conditions
hysical 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. Backi'low Device and/or
["CUrMt Test Data Needed
Building Official �— Date
Zoning Official Date 4o-
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
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 )/ N
o ou 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 �s:
Y /1
If s&, -List:
ariance:
%S'4 , List!
the
9/28/05 Page 2 of 4
Intake to complete the following:
Y/N
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
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
Y 1N
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
V1 N
is on public water and sewer?
Y(N
Wil ou be putting up a new sign of any kind? If so, obtain
proper Sign permit.
Permit #
Y lQ
Willl ere
e be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Y
Is tior sales of Fireworks?
If so, obtain a copy of F/R permit.
Permit #
Proffers:
Y/
Ifs , st:
1ReviOwer to complete the following:
Square footage of Use:
Y / N
Permitted as: u S" C u
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces:
Y/N
Items to be verified in the field:
Inspector Name & Date:
Notes
7 /zzvuD rage j or 4
3/28 /US Page 4 of 4
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