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HomeMy WebLinkAboutCLE200700180 Legacy Document 2014-01-22Application for Zoning Clearance 3-!roning Clearance = $35 PLEASE REVIEW ALL 3 SHEETS �htG�N�P ,oF�� Tax map and parcel: 6(a 100— 00 —00 — /3/A O Existing Zoning: Parcel Owner: m 0 1tA M N\ & Q , J "444 k R Parcel Address: 16DO C AST Rio Qo-tN-� City C R"tl741es v d (e State V ON zip '2-29 I n n ip suite or floor) p Contact Person (Wh should we eahl /vrir�ite concerning this project ?): ©1'�'�MM�� • {� • s iii (�C%i Address I Q 2- SS . EAST /Yf {�ie1c ,g %%� F E % City. �' �SOhl aG(KG State V A' Zip 2-1 Daytime Phone �( 17) 479 — 5(-S'7 Fax # C__) Business Name /Type: T V,•1 sTPt12 W 0,G L-ESS Previous Business on this site: E -mail Proposed use: CEEL PH--ONE Accecatzies a�A` _ Il`%M10A) 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. �zo Signature ofl3dsiness Owner or AFent Date Print Name APPROVAL INFORMATION [VfApproved as proposed [ ] Approved with conditions [ ] Backflow device and /or current test data needed for this site. Contact ACSA 977 -4511, x119. [l d'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 Zoning Official Other Official Date 1 Date o"7 Date FOR OFFICE USE ONLY CLE # JX 7 /90 [ j 0 j f _ y Fee Amount $ 2- Date Paid By who? �� j Receipt # - 1 ®Ck# `� / V� By: w 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 Applicant to complete the following: Do you have one of the following? YES ax Map and Parcel Number and or; Address of use (include unit or floor if appropriate) ❑ YES 9 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 V 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? If so, give applicant a Certified Engineer's Report (CER) packet. ❑ YES ® 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 ® 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 ;�YES Dept. FAX DATE �R NO Is on public water and sewer? ❑ YES 5Z NO Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # ❑ YES YL NO Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # ❑ YES E, 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: 511106 Page 3 of 4