HomeMy WebLinkAboutCLE200700183 Legacy Document 2014-01-22Application for
Zoning Clearance
❑ Zoning Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
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Tax map and parcel: 7 -P l Existing Zoning: G f%
Parcel Owner: (�-_ o U , 66/ a✓{�hP,^ 4✓ e,
Parcel Address: IK00 574t 5` City State Zip 229Vt
(include suite or floor)
Contact Person (Who should we call /write concerning this project ?): l-K Q V r (lam R/Y'Q F /\ ''/Y
1Ct.r 1 Sn ( 6"rc S.
Addresk 10PJB �� ,��n s ��17 1"� City (" �t Q�I^�OI PS//�� /�� 11 State f_ Zip u9/1
Daytime Phone ( - Fax # l%3 E -mail "w r%2 , Ora
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Business Name /Type:
Previous Business on this site: 111-4
Proposed use:
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.
Signature of Business Owner or Agent �o 0A k tf?Q446ee44r a Date tt ,
[°, a i li o �J/^m21^hPiYYI C�1Ci7G� �..Wa6AJf.Crne,
Print Name `'F j VCH P ,-i.5 Ma ncZj
APPROVAL 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.
] This site complies with the site plan as of this date.
Building Official
Date — ,S( `Sn
Zoning Official
Date 2t/ Dpi
Other Official
Date
FOR OFFICE USE ONLY CLE #
Fee Amount $ Date Paid 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
Applicant to complete the following:
lou have one of the following?
YES ❑ NO
Tax Map and Parcel Number and or;
Address of use (include unit or floor if appropriate)
V YES ❑ NO
ou 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 us nd /or; App r K h
he square footage o 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.
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Zoning Tech to c
Violations:
❑ YES ❑ NO
If so, List:
Variance:
❑ YES ❑ NO
If so, List:
the
Intake to complete the following:
❑ YES ❑ NO
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
❑ 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
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, 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 ❑ NO
If so, List:
511106 Page 3 of
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