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HomeMy WebLinkAboutCLE200700197 Legacy Document 2014-01-22Tax neap and p Parcel Own Parcel -vp iiL,aLlVii 1V1 Zoning Clearance (include suite or floor) ❑ Zoning Clearance = $35 PLEASE REVIEW ALL 3 SHEETS Existing Zoning: P DS 0— State Contact Person .(Who should we call /write concerning this project ?): f,+y.%i Zil &Me) Address _ ,q rr ,�F5 A13dmr City State Zip Daytime Phone t✓ �� 3� 0 Fax # C___) E-mail Business Name /Type: e-li-AU�1C✓% Previous Business on this site: � t :,A r� 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 b them. -0:2 i ature of Bu Ines} Owner or gent Date fl , CO 1 /1Ii�y,✓1� Print Name APPROVAL INFORMATION [ ] Approved as proposed [ ] Approved with conditions ] Backflow 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 complies with the site plan as of this date. Building Official Zoning Official Other Official �. Date Date Date FOR OFFI ) E # y Fee Amount $ Date Paid By who, Rece pt 11 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 of4 Applicant to complete the following: Do you have one of the following? ❑ YES ' NO Tax Map and Parcel Number and or; Address 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. 4/0 �V i Or .Zoning Tech to Violations: ❑ YES If so, List: Variance: ❑ YES NO If so, List: e foll 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 [X 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 oil 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 ��offaany kiinnd? ?� If so, obtain proper Sig �r��9 PI�.V ! ! V Permit # ❑ YES NO Will there be any new construction or renovations? If so, obtain e p )p8h PerMi Permit # —� T ❑ YES [ NO Is this for sales of Fireworks? If so, obtain a copy of F/R permit. Permit # Proffers: ❑ YES El NO If so, List: SP's: ❑ YES E� 0 If so, List: Reviewer to complete the following:) Square foot of Use: �N Permitted as:❑ o WINS J Under Section: a ya ,/ (0 Supplementary regulations section: (544e, )� ' - � Parking formula: Required spaces: n, Ito ❑ YES ❑ NO Items to be verified in the field: Inspector Name & Date: Notes �L! �/euP I14'- 5/1/06 Page 4 or4