HomeMy WebLinkAboutCLE200700173 Legacy Document 2014-01-22Tax map and parcel:
Parcel
Application for
Zoning Cleave
LZoning Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
Existing Zoning: PD MQ
is
Parcel Address: ) h - a`�', .ditty n v State Zip
(include suite or floor) S ��/�f ref �(d
Contact Person (Who should we call /write concerning this project ?): ty 17 /V n r
Address / 2 U o o /� �zca �le City '� a rn u t v l� State (_14 Zip Z
Daytime Phone U 175`' ���� Fax # C L ?Z g 7% ` l �!� E -mail
Business Name /Type:
Previous Business on this site:
Proposed use:
i
,/� .,, , - _- ��-
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 d accurate to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will
abide by em.
Signatu of Business Owner or Agent
Print Name
APPROVAL INFORMATION
[ Approved as proposed
Date l .
F-v' ac loevice Ind /or rrent Test Data Needed tact Test
977 -4511, x 119
[ ] Approved with conditions
] Backflow device and/or current test data needed for this site. Contact ACSA 977 -4511, xl 19.
] 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 J Date 8 o
Other Official Date
FOR OFFICE "" CUSE ONLY CLE # 'ZOO -7 1 %�
Fee Amount $4. Jo na Date Paid"? -0 7 By who? LAAja r y �octbzda f�EReceipt # (0l`2Ck #� By:
County of Albemarle Department of Community Development
401 McTntire Road Charlottesville. VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -41.26 5/1/06 Pase 2 of4
Applicant to complete the following:
Do you have one of the following?
1i YES ❑ NO
Tax Map and Parcel Number and or;
Address of use (include unit or floor if appropriate)
❑J 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.
, oning Tech to c
Violations:
❑ YES E�/NO
If so, List:
Variance:
❑ YES F�l NO
If so, List:
the
Intake to complete the following:
❑ YES 2<O
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
❑ YES [Z/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 YNO
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?
❑ YES ❑ 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, obt UM
pro er it.
Permit #
❑ YES [�(NO
Is this for sales of Fireworks?
If so, obtain a copy of F/R permit.
Permit #
Sbp02DU4 -- (f/
Proff s:
S ❑ NO
If so i
SP's:
,u YES ❑ NO
If so, List:
5/1/06 Paee 3 of 4
M
Reviewer to complete the QwIn g:
Square otage of Use: UU
e 'o
YES ❑ NO
Permitted as:
Under Section: .26A
Supplementary regulations section:.
Parking formula: LqZ00 d-61
Require A spaces:
FYES
9NO
ms to be verified in the field:
Inspector Name & Date:
Notes
5.
5/1/06 Page 4 of 4
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