HomeMy WebLinkAboutCLE200700167 Legacy Document 2014-01-22Application for
Zoning, Clearance
Zoning Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
"�x�N�P OF AL/�l
x�,
Tax map and parcel: Ow o ILV/Q�( m - mm Existing Zoning: Ha
Parcel Owner: Aol, U..
l 0�1�JI State Zi
Parcel Address: City
(include suite or floor) j
Contact Person (Who should we 11 /write concerning this project ?):
Address v s C City State �� Zip r -31 Daytime Phone �L J ' � �[) Fax # 3� `� 7 3 --0 5-;; E -mail Ckm m v ��t� 71.3 J J�� 1 �
Business Name /Type: Gr h1�fr� t i
Previous Business on this sit
Proposed use: C'(
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 accu to to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will
abide by them..
410 7'
or Agent I Date
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.
J No physical site inspection has been done for this clearance. Therefore, it is not a detennination of compliance with the existing site plan.
] This site complies witlylthe site pjn aKofjthis date. ,
Building Official
Zoning Official
Other Official
r
Date —) f � -1-- -1
Date
Date
FOR OFFIC SE ONLY # lJ I lf[ ec .�/�%�/�Q��
Fee Amount $ Date Pai � who? L.� ° �_ Reipt t�EUb —fie# — By:
County of Albemarle Department of Community Development
,101 MrTntirP Rnnrl C'harinttPCvillP_ VA 22902 VniVP.- 61141 296 -SRi2 Fax: (41d) 972 -4126 Si1106 Nap.? Ufa
Applicant to complete the following:
Do you have one of the following?
YES FT NO
Tax Map and Parcel Number and or;
Address of use (include unit or floor if appropriate)
❑ YES i NO
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
P] YES ■ NO
Y
=l�l-i
Variance:
❑ YES NO
If so, List:
Intake to complete the following:
❑ YES 4NO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's R;No rt (CER) packet.
F7 YES
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. F DATE
El YES NO
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
7 YEDept. FAX DATE
S ❑ 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 er t .
Permit #9 �
❑ YES [2' NO
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
❑ YES [ NO
Is this for sales of Fireworks?
If so, obtain a copy of F/R permit.
Permit #
Proffers:
❑ YES NO
If so, List:
SP's:
❑ YES NO
If so, List:
5/1/06 Pave 3 oP4
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 Name & Date:
Notes
5/1/06 Page 4 of 4