HomeMy WebLinkAboutCLE200700177 ApplicationTax map and parcel:
Application for
Zoning Clearance W �.�
ri.��`oning Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
Existing Zoning:
Parcel Owner: ((�� `'�(e� T `I 1-`� � CJ4A_._ e- � i'( AI•. -�.i� 1.� � (_A-4 0 %--I
Parcel Address:"1-1 -6 �, 1-�a •a�i *-B '�4� City C I V 17 t le State 1{' _11� Zips t i7�
(include suite or iloo -�,
Contact Person (Who should we �cajll /write concerning this project ?). .1� iGt1'�° 1J n i G IN+
Address 1'11 lLA OP3 � ��� GSl � ��� 4" °City��► � 1� State zip
_
Daytime Phone lq 9'-1 5 - �I � (Fax #(j4 OY-) I �
Business Name /Type: <:_� CA in '� C,) (,1 Y)
Previous Business on this site:
Proposed use: X G5 �j i� 1� J�' g, �,o it ro 1 {mac Q, 10
i1 o s'a
I ' 1
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 -9pace 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.
�� )
�Si nature of Business Owner or Agent Date
Print 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. d C,
[ ] No physical site inspection has been done for this clearance. Therefore, it is not a determinate of compliance wit i the isting sit an.
[ ] This site complies with the site plan as of this date.
Building Official �— Date
Zoning Official Date
Other Official Date
FOR OFFICE USE ONLY CLE - -�
Fee Amount Date Paid °7'd ' lT 7 By who ?) S C_ 1I L Rec ipt # �Ck #�Cx By:
-County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 511106 Page 2 of
Applicanf to complete the following:
r-
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
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 pomplete the
Violations:
❑ YES IVI NO
If so, List:
Variance:
❑ YES V/NO
If so, List:
Intake to complete the following:
❑ YES [QO
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
NKYES ❑ 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 i % c L7 i
❑ 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
Health Dept -FAX DATE
��� NO
Is on public water and sewer?
❑ YES [1GO
Will you be putting up a new sign of any kind? If so, obtain
proper Sign permit.
Permit #
❑ YES TO
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit # ,
❑ YES (ANN
Is this for sales of Fireworks?
If so, obtain a copy of F/R permit.
Permit #
Proffers:
❑YESONO
If so, List:
SP's:
❑ YES Q'NO
If so, List:
5/1/06 Page 3 of
Reviewer to complete the fol ing:
Square footage of Use:
Permitted as W�/Vp
A
Under Section:
Supplementary regulations section: K I A
Parking formula:
Required spaces: bt(S ,ke,. pl yA
❑ YES 4d NO
Items to be verified in the field:
Inspector Name & Date:
Notes
5/1/06 Page 4 of 4