HomeMy WebLinkAboutCLE200700194 Legacy Document 2014-01-22Application for �g
Zoning Clearance
I/ Zoning Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
Tax map and parcel: TM U (I PAR �3 ` W'� Existing Zoning:
Parcel Owner: MIA R � k U 4 , l-_-l.j-- 00C—Di-c NCO l %
Parcel Address:Jgo 4� IJ ° - U - L.A <rr ('0 City �iV �` 0,1 t�,,o _ State v !-C ZiPX%
(include suite or floor)
Contact Person (Who should we call /write concerning this project ?):
Address ��/ �T �- r `C.`�V ► Ili1� ��-
City State V Zip aaaol
Daytime Phone Fax # GtCL•Uom � ' �J E -mail I*J
Business Name /Type:
Previous Business on t
Proposed use: Lo y,,- s u r u a i v\-c- !2o NM n•,i — 0 V _
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.
4
Si nature ofAusmess Owner or Agent Da
M rb Q-1 --
Print Name
APPROVAL INFORMATION gacUlow Device and/or
[ 1 ]Approved as proposed [ /Approved with conditions I Current Test Data Needed
[ ckflow device and /or current test data needed for this site. Contact ACSA 977 -4511, x119. 1"oritact AG"SA 977 -4511, x 119
[ o physical site inspection has been done for this clearance, Therefore, it is not a determination of compli wi ie existing site plan.
[ ]
Tlij s''s�ii ^c^omplies with the sit��p��lan s of this d�aote.
' `�VIXrCGt{6a2l�i�GS' �l�CGt'ILQ
Building Official
Date
Zoning Official
Date
Other Official
Date
FOR OFFICE jI,SE ONLY CLE #
At Fee A $�. I— Date Paid n By whoicz", Q-
Z to
Receipt 16 Ck# 1004' By;
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 5/1/06 Page 2 of4
Applicant to, complete the following:
;71 have one of the following?
YES ❑ NO
Tax M p and Parcel Number and or;
Addr ss of use (include unit or floor if appropriate)
YES ❑ NO
Do you have a Floor Plan (sketch or an architectural drawing) that
includes the following, and if so please provide it with the
application?
The total square footage of the use and /or;
The square footage of each room or area of use;
Use of each room or area
If using less than the entire structure, note the location within the
structure.
'S "�� �� . -t-
zoning Tech to
Violations:
❑ YES ZINO
If so, List:
Variance:
❑ YES dNO
If so, List:
the
Intake to complete the following:
❑ YES ❑INO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
❑ YES VNO
Will there be food preparation?
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from
Health Dept. FA DATE
❑ YES NO
Is parcel on private well and septic?
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from
;?h Dept. FAX DATE
YES ❑ NO
Is on public water and sewer?
❑ YES NO
Will you be putting up a new sign of any kind? If so, obtain
proper Sign permit.
Permit #
❑ YES [ENO
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
❑ YES NO
Is this for sales of Fireworks?
If so, obtain a copy of F/R permit.
Permit #
Proffers:
❑ YES NO
If so, List:
SP's:
❑ YES RZNO
If so, List:
5/1/06 Page 3 of
Reviewer to complete the followings �O
Sg44are footage of Use: 4
Z3-?,ES ❑ NO �,;,$ j _ - - n GQ�I�
Permitted as: /I DYE
Under Section: �� • 6
Supplementary regulations section: a
Parking formula: �a �l 06 r C(6Q ( �� ;L00
Required spaces: � y
ES �0
terns to be verified in the field:
Inspector Name & Date:
Notes
511106 Page 4 of 4
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Last Updated 10/19/2001
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