HomeMy WebLinkAboutCLE200700156 Legacy Document 2014-01-22�� pF /+�
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A pp lication for Zoning Clearance
OFFICE USE ONLY
04oning Clearance = $35 CLE #
PLEASE REVIEW ALL 3 SHEETS Check # Date: G
Receipt # 1, $`iS�3 Staff:
PARCEL INFORMATION
Tax Map and Parcel: ®6 l W `0J 0 0� U2- L Existing Zoning
Parcel Owner:
_ v
Parcel Address: 13Jet St,►�►� ►-�� Lc- r. City Q'tis—*' I 3 r` ate
(include suite or floor)
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APPLICANT INFORMATION (_,� S
Who should we call /write concerning this project.
Zip emu/ Z=
Address : C,, Le C G,w,_ ,n 1'x City x,11 �. �� �e State Zip
Office Phone:( ILI) U?Cell# q�� -S Fax# E -mail
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PRIMARY CONTACT
Business Name/Type:!
Previous Business on this site:
Proposed use: fa—tc
Circle (if applicable): Z Firework/ / Christmas Tree
2- -1"
SEE CONDITION§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 th st of my knowledge. I have read the conditions of approval, land I understand them, and that I will abide by them.
Signature Printed l-4
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APPROVAL INFORMATION
[ ] Approved as proposed Approved with conditions
[ ] No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
site plan.
[ ] Th'ite lie with the site plan as of this date.
Building Official Date &(f 1 l v 1
Zoning Official ✓����U(/ Date 6 I
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:
n Y/N
Do you have one of the following?
Tax Map and Parcel Number and or;
O/ dre of use (include unit or floor if appropriate;
N
you ss 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
9/28/05 Page 2 of 4
Intake to complete the following:
Y' N
Is use m LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/N
Will-d 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
Is 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
public water and sewer?
Will you be putting up a new sign of any kind? If so, obtain
proper Sign permit.
Permit #
Y
re be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
N
s this for sales of Fireworks?
If so, obtain a copy of F/R permit.
Permit #
Proffers:
Y/N
If so, List:
Variance: SP's:
Y/N Y/N
If so, List: If so, List: