HomeMy WebLinkAboutCLE200700162 Legacy Document 2014-01-22Application for
Zoning Clearance
❑ Zoning Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
Tax map and parcel: �I I�JI J - " �! d Existing Zoning: \
Parcel Owner: ��/C b�'1 P_o2 - 6 ,M6A, 4 yi —raim' IN
Parcel Address:
(include suite or floor) J>�p iA i
Contact Person ffh o should we call/write concerning this project ?): Le6w_ C0.5ne2
Goo
Address 5k o`i'nD 2AC CityCVYif l tIC State a ` �0- Zip 0-�Rq
Daytime Phone 631)991 - 011 Fax # `U 917 L-Q I d 3 E -mail eb`� ®� e���S�' 1obGU(l • ✓"-f-
tia41 LIK i - 1CXY3
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City Chy I64csy l ( (C State y t o-, Zip'Wl I
Business Name /Type: 3
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Previous Business on this site:
Proposed use: +rY�c'�iCCIA
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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.
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 of my knowledge. I have read the conditions of approval, and I understand them, and that I will
abide by them.
t OL
'4taturre f Bus` lne�s Owner or Agent Date
VU rfiVX'
Print Name
APPROVAL 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.
Building Official Date
Zoning Official Date 10w
Other Official Date
FOR OFFI S NLY , �� (�1j I&PkE!! Fee Amount $� Date Paid6 lam— VBy wh ipt # �Ck# By: CA��
Uounty of Albemarle Department of Uommunity Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 5/1/06 Page 2 of 4
Applicant to complete the following:
7 ou have one of the following?
YES ❑ NO
Tax Map and Parcel Number and or;
Address of use (include unit or floor if appropriate)
❑YES 7 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.
Tech to complete the
Violations:
❑ YES Z'NO
If so, List:
Variance:
❑YES 7 N
If so, List:
Intake to complete the following:
❑ YES i NO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's RVCo (CER) packet.
El YES Will there b preparation?
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from
Health Deptr DATE
❑ YES O
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
7YES Dept. FAX DATE
❑ NO
Is on public water and sewer?
❑ YES ❑ NO
Will you be putting up a new sign of any kind? If so, obtain
proper Si e
Perpit #
-E� YES ❑ NO
Will there be any new construction or renovations?
If so, obtaia the proper Permit.
Per-- =t #
❑ YES NO
Is this for sales of Fireworks?
If so, obtain a copy of F/R permit.
Permit #
Pro rs:
EZ YES ❑ NO
If so, List:
SP's:
YES ❑ NO
If so, List:
5/1/06 Page 3 of 4
Reviewer to complete the follo
Square footage of Use:
YES ❑ NO
Permitted as: SYbp- oArIce, - yyej -, CA I
Under Section: d✓A • a'' d�J•0�•
Supplementary regulations section: in a
Parking formula:
Required spaces: )
❑ YES 91NO
Items to be verified in the field:
Inspector Name & Date:
Notes
5/1/06 Page 4 of 4
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