HomeMy WebLinkAboutCLE200700193 Legacy Document 2014-01-22tl�J�1111 A t1V11
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unn", Zonin g Clearance
0,'Zoning Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
Tax utap and parcel: 0 10 0 01 —O Y " `' / o Existing Zoning:
Parcel Owner:
Parcel Address: � ^ p( `7 0 City State VA ZipQ A 901
(include suite or floor)
Contact Person .(Who should we call /write concerning this project ?): / j /
IF
Addresses ��''1'�!1rLtI % City �dt,� /vT l�l� State yx Zip
Daytime Phone ���.�- /�� 3. - Fax # (� E -mail % /A'I ' ee 4 4 e mod'a'l ��li
i 7
Business Name /Type: lr�_
Previous Business on this site:
r
Proposed use: ���, WeJ ay IN
A— to
lr e- Y.
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 ent Date
Print Name
APPROVAL INFORMATION
[ ] Approved as proposed [Vf Approved with conditions
[ ] Backtlow device and /or current test data needed for this site. Contact ACSA 977 -4511, x 119.
[ ] 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 cons lies ith th Site plan as thus date,
.„��'ia�l �,sx,.t 1n `� hoa- ((fi _ .�-rxlt%-t�w 44, /.PI-
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Building Official
Zoning Official
Other Official
-
`�►1 V+r�
1� •
Date
FOR OFFICE % USE ONLY ry j CLE # � 00 �
Fec Amount $ 1. S -f00 Date Paid By who? Z-1 11_ Receipt 11 467 ! Ck# 253 By: e_
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
,, Apppcant to complete the following:
Do you have one of the following?
0/�IES ❑ NO
Tax Map and Parcel Number and or;
Address of use (include unit or floor if appropriate)
�ES ❑ 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..
Zoning Tech to complete the following:
Vio Etions:
YES ❑ NO
If so, List:
/-fib d
-1 a al
0 l �
6b
Variance:
❑ YES [� NO
If so, List:
Intake to complete the following:
❑ YES LJ iv0
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet. "
[:1 YES [�'NO 'P l fg �d (l"CA
Will there be food preparat o1 ?
X15 t
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from
Health Dept. FAX DATE
❑ YES [9-N0
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
[9'-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 �7 f
Permit S
❑ YES ®,,K0
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: �a �
F-1 YES D NO
If so, List:
Reviewer to complete the folio wig:
........... .
Square footage of Use:
['ES ❑ N
Permitted as: ,�✓ '�"
Under Section:
Supplementary regulations section:
Parking formula:
r
Required spaces: (�
Inspector Name & Date:
Notes
511106 Page 4 of4