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HomeMy WebLinkAboutCLE200700170 Legacy Document 2014-01-22Applicatio Zoning Cli ifor �OF 4La rance��NGIN�P L'Zoning Clearance = $35 PLEASE REVIEW ALL 3 SHEETS Tax map and parcel: 1*"An SK . PA lLe­-L 3 ? Parcel Owner: yo W Se-r , I- L C Existing Zoning: H c Parcel Address: j 6 G� S (oGkF +rf/ �f �ti� City e r /t c State V4, Zip 2 Z 9o� (include suite or floor) 1 // Contact Person (Who should we call /write concerning this project ?): L/-12!!:t, Address 7.5' A04fifl% d� �%.v k City �2 ^�w � State Zip Daytime Phone y( 3Y) 7,6O %2_7 8 Z Fax # L E -mail -hg C $ A/u P h Business Name /Type: �' L21:� 1-0A —f' 2 /�SL.P2 r LA4- �Jq i , nJ Previous Business on this site: E=X is 7//'��i^�� %>" C /✓J �1'S �4 1zi`►�'fJ+i l/►14�f�"i Proposed use: C6' -yiArc iQ ACS 1-0,M' r.� Parr S ri—I 41- "'�SI 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. /_ ;?_071 gnature of Owner or Agent Date L - r✓ Print Name IfOVAL 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. ] Thicomplies with t e sitepia s of this date._ Building Official V Date Zoning Official Date 7 0 Other Official Y Date FOR OFFICE USE ONLY CLE # 2_61D­7 _170 Fee Amount $ 15 00 Date Paid -07 By who? Receipt # Ck# By: 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 4 Applicant to complete the following: Do you have one of the following? 2YES ❑ NO Tax Map and Parcel Number and or; 7YEe of use (include unit or floor if appropriate) S ❑ 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. �a� -170 ZoninL Tech to complete the Dtions: ES ❑ NO IfsorLG�.�6 V riance: YES ❑ NO If so, List: Q.. Intake to complete the following: ❑ YES Is use in LI, or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. ❑ YES NO Will there bation? If so, give applicant a Health Department form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE ❑ YES O W y 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 ES ❑ NO Is on public water and sewer? ❑ YES ❑ NO Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # 5?'9S ❑ NO Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # 7 (n®% a-��� ❑ YES ®ENO 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 [INO If so, List: 5/1/06 Page 3 of 4 R,eviewer.: to complete the following: �`�� Square footage of Use: [YES ❑ NO p Permitted as: a ( I , " 16 "t? Under Section: 9 •C;.( (A 0 1 Supplementary Parking formula: s section: �0© M -fD06t s� ., Required spaces: ❑ YES ❑ NO U� Items to be verified in the field: `il OnQ !/lam Inspector Name & Date: Notes 5/1/06 Page 4 of 4