HomeMy WebLinkAboutCLE200700189 Legacy Document 2014-01-22Application for
Zoning Clearance
❑ Zoning Clearance = $35 .
PLEASE REVIEW ALL 3 SHEETS
Tax map and parcel: � � / CtC:� — (� C7 � Cf� tJ )-3 c) (J Existing Zoning: �
Parcel Owner: 1 SG, t�C,i fl ��'� tai (s'��� y 1 ° lq r +(' `r �t 1 p
Parcel Address: 2 A I" d z, �; Q . City C . � +� l' TCS u'1� `ei State , y I Zip
(include suite or floor)
Contact Person (Who should we cal write co cerning his project ?): ,s 7 / r C#V 1
Address �( ° ! �`� fee �- City 1_))rce�hq %°Z State Zip
Daytime Phone i � Fax # C__) M E -mail AIIA
Business Name /Type: //� /I
Previous Business on this site: �Ti t'G k
Proposed use: 1311 ✓
of A oo..
' �x�N�P
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' a 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 the
v 7 �)
Signatu of B siness Owner or Agent Date ,
Print Name 5 7,21)A/4 F l CAI V A /f-,.
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
Zoning Official
Date
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 4
Applicant to complete the following:
Do you have one of the following?
BYES ❑ NO
(Tax Map and Parcel Number and, or;
Address of use (include unit or floor if appropriate)
7 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.
'Loy,
Tech to complete the
Violations:
❑ YES NO
If so, List
Variance:
4 YES ❑ NO
If so, List:
2— a� 9g —ll
Intake to complete the following:
❑ YES [Z NO
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
❑ 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 ❑ NO f 14LI iC/
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 Is o pu is ater and sewer?
2 YES ❑ NO
Will you be putting up a new sign of any kind? If so, obtain
proper Sign permit.
Permit #
YES F-1 NO
'Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit # 2 o 6-1 9 &1 A
❑ YES Z NO
s
Is this for ales of Fireworks?
If so, obtain a copy of F/R permit.
Permit #
Proffers:
❑ YES )z NO
If so, List:
SP's:
Q YES ❑ NO
If so, List:
5/1/06 Page 3 of
Reviewer to complete the following :�"
Square footage of Use:
0- YES ❑ NO / /
Permitted as: L4r&, SAbai
Under Section: �7- 2-1-j ✓ `/ 4+ Gam_
Supplementary regulations section:
Parking formula: ��� n �IIf'Y� <-'✓
Required spaces:
❑ YES X. NO
Items to be verified in the field:
Inspector Name & Date:
Notes
5/1/06 Page 4 of 4