HomeMy WebLinkAboutCLE200700168 Legacy Document 2014-01-22Tax map and parcel:
Application for OVA Zoning Clearance zoo-7 4tGINP
D41!9oning Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
Existing Zoning: 0 L) t S ` -
Parcel Owner:
Parcel Address: S t� City C ,\,4tkV State Zip u-SJ
(include suite or floor)
Contact Person (Who should we call /write concerning this project ?): i-^ky1 Ad
Address City State VA Zip 2:L100(
Daytime Phone &() 2-VL 21W-0 Fax # (__)
Business Name /Type: F f,-, ky\ev1C e
Previous Business on this site: 1 1 Q
Proposed use:
E-mail a�@�W�k l�� ��� w.c�i`• Co•- -�
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.
6 / 2�/ 2 0 C)
Signature of Bu ness Owner or Agent Date
Print Name
! u know Device and /or
AL INFORMATION
I as proposed
current Test uaau
[ ] Approved with conditions Contact ACSA 977 -4511, x 119
B kflow device and/or current test data needed for this site. Contact ACSA 977 -4511, x119.
o 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.
s--
Building Official
Zoning Official M
Other Official
Date -s
Date
Date
FOR OFFICE USE LY CL p � ,�, a / y
Fee Amount $ 3 •� Date Paid who? Recei t # 4 Ck# B :
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 of4
n
'Applicant to complete the following:
Do you have one of the following?
❑ YES ❑ NO
Tax Map and Parcel Number and or;
Address of use (include unit or floor if appropriate)
❑ YES ❑ 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
Violations:
❑ YES V1 NO
If so, List:
Variance:
❑ YES NO
If so, List:
Intake to complete the following:
❑ YES 9 NO
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
❑ YES V NO
If so, give applicant a Certified
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 V 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
Health Dept. FAX DATE
YES ❑ NO
Is on public water and sewer?
Wj
YES [Iti NO
Will you be putting up a new sign of any kind? If so, obtain
proper Sign permit.
Permit #
❑ YES �' 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 0
If so, List:
511106 Page 3 of
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
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