HomeMy WebLinkAboutCLE200700166 Legacy Document 2014-01-22r
Application for
Zoning Clearance.,,,
pY At.1,T�t
�Y
Clearance
OFFICE USE ONLY
CLE # 1<2-
oning = $35
Check # Date:
PLEASE REVIEW ALL 3 SHEETS
Receipt # Staff:
PARCEL INFORMATION
'--7 S L7 V / ► 1
Parcel: Existing Zoning P
Tax Map and t`J
Parcel Owner: VA. U f L CQOOA6.:j
Parcel AddresO City Nviao- sU, State 04, Zip e2 �'03
(include suite or floor)
PRIMARY CONTACT
I)AN smcy
Who should we call /write concerning this project? p
Address: �50 1 ' e.,oc- n,- uelooy- City VC22r-/CJL (L ) State UA Zip
Office Phone: `%( D�j) Cell # %�3 -927-Z )/d Fax # �/D 9SS3�33 E -mail
APPLICANT INFORMATION CZC
jn
Business Name /Type: OF CNtw,;,," K:�iC /fit /.�5c X65
_`
Previous Business on this site j%lA) �� 130 y d3'Q,� °Z 2' a -7 �b % -&
Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any
additional information that you can provide: PeCPt6VU6 —17-) (64)i)1CT A1U-V6nL - -mV leek
LA -,-:5 " C '/ f I!gE 1GU- -S , -011pe z,z — ; i D i!t E; z ���• �"
*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 owt . or have the owner's permission to use the space indicated on this application. I also certify that the infonnation provided
is true and accurate i est of my latowled . I have read the conditions of approval, and I understand them, and that I will abide by them.
Signatur % '�' Printed
APPROVAL INFORMATION
[ ] Approved as proposed [ ] Approved with conditions 4eni /
Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, x1
[ ] 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 c pkes wj'th he side plan as of this date. r
Notes: J 4,, (/J
uilding O icial Date
Zoning Official Date
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
5/1/06 Page 2 of 3
5,
07
m
Intake to fete the following:
❑ co YES NO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report ER) packet.
❑ YES NO
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
❑ YES ❑ NO
Is parcel on private well or piiblic, water?
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
❑ YES ❑ NO
Is parcel on septic or public sewer?
M--Y'ES ❑ NO
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit, —
Permit # % 2-M 7
❑ YES LJ'Nv
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Goninl? 'l ecri to complete the tonowim
Reviewer to complete the following:
Square footage of Use:
❑ YES ❑ NO
Permitted as:
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces:
❑ YES ❑ NO
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
❑ YES ❑ NO
If so, List:
Proffers:
❑ YES ❑ NO
If so, List:
Variance:
❑ YES ❑ NO
If so, List:
SP's:
❑ YES ❑ NO
If so, List:
511106 Page 3 of 3
Jun 21 07 04:57p p.1
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Jun 21 07 04:58p P.1
pt A
I'fRCtl�
COUNTY OF AE[ RE I NLA- LE
office of the Fire W arshal
Dcpartment of Fire Rescue
46o Sragecoach Road, Suite k • Charlottesville.,'V'irginia 229o2 -6489
Voice: 434.2.96.5333 • FAX: 434.9724123
www.ACFireRe,scuc.org
FIRE PREVENTION PERMIT APPLICATION
APPLICATION DATE:
DATE OF ISSUE:
APPLICANT NAME:
AFTER HOURS TELEPHONE;
ADDRESS: �.. �� /, 'L
PERMIT NUMBER: L�
EXPIRATION DATE:
DAYTIME TELEPHONE:
MOBILE TELEPHONE: �• -' r'
frr / ,. -..I!
CITYIZIP CODE:
PROPERTY OWNER: TELEPHONE;
ADDRESS: I� CITYISTATEIZIPCODE,
TYPE b EXTENT OF ACTIVITY: ' I - r'
LOCATION OF THE ACTIVITY: ! / •1 / !' `� r"
(Um• TAr Map, ADC Mapbook, or Spoci}10 Dlncdonn as 911o)
.APPROVED ❑ NOT APPROVED ❑ APPROVED WITH CONDITIONS
CONDITIONS: ❑ Fire must be attended et all timOS•
❑ Adequate means of extinguishment must be on site at all times.
❑ Must 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 time;—
❑ 15 February — 30 April; Open burning permittod between 1600 Hours (4:OOPM) and 0000 Hours (Midnight) only.
CP Must correct any Code violations round.
n
STATEf,4ENT 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 ownerloperator, or a duly authorized agent, acting on behalf of the owner, for all activities at the abovo referenced property
or location. As such, I horeby agree to comply fully with all requirements In the Albemarle County Fire Provondon Code governing the
operation 1 wish to conduct, if there has boon any false statement or misrepresentation as to the material fact In the application, data, or
plans on which the permit or approval wan based, the Fire Official may revoke this Formlt.
OWNER/AGENT SIGNATURE, DAVE ' V F71 PREVENTION INSPECTOR SIGNATURE
' ✓'�. -, ', r, �. r OFFICE USE
l J
Associated Fees, 5
Check # Cash $
White - Office
Yellow - Applicant Receipt #
We will provide the highest Quality services to protect and preserve the
lives, property, and environment of our coinmumity.