HomeMy WebLinkAboutCLE200700200 Legacy Document 2014-01-22.- vppxi%,aL1V11 xvi
a Zoning Clearance
Tax map and p
Parcel Owner:
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❑ Zoning Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
LL C
Parcel Address: ���� JL°fn /l1f3 /+' �iJ• .�� /o..� City
(include suite or floor)
Existing Zoning:
State b11 ZIP � f
Contact Person .(Who should we call /write concerning; this project ?):
Address � c5elnl Ao1 T City C`e11^10 z°s y/11 State v Zip�22 y1
Daytime Phone (; /� '- J�� / Fax # v ��S 77 3 E -mail d��C�r� ®(°f!CA)SWel4 �,. I
Business Name /Type: G- V) sme -, C /ZC
Previous Business on this site:
Proposed use:
G,
t°
S
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
Signa re i Sllles, Owner or A ent�9 � Date
Print ame
APPROVAL INFORMATION
,(/rApproved 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 �— Date 4�i0 1
Zoning Official Dated /,�"
Other Official Date
Fee Aniount $�%y Date PaidotBy who? Rec 11 Ck By:
►'r't!fi; 4 r ' -
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 5/l/06 Page 2 of
Applicant to complete the following:
Do you have one of the following?
X 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.
Zoning Tech to complete the following:
Violations:
F fsoYES F1 NO
, List:
G4,—
d 3 —tea/
Variance:
❑ YES Z NO
If so, List:
Intalce to complete the following:
❑ YES 0 NO
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
❑ YES Z NO
If so, give applicant a Certified
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 ZI 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
0 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 # 6 °?--' IK56 4, .i
❑ YES NO
Is this for Ales of Fireworks?
If so, obtain a copy of F/R permit.
Permit #
Proffers:
❑ YES JZ NO
If so, List:
SP's:
Z YES ❑ NO
If so, List:
rci91— -7O
e7 —if
Reviewer -to complete the following: fa
Square footage of Use: y 3G
^ YE ❑ NO j
K mitted S 4
as: ,i :1S ;�� ,+tiA�'tv^, 1
Under Section: iqi o
Supplementary regulations section:
Parking formula: i _ d ()J ` � 0 J �t 10
Required spaces:
❑ YES ;n NO
Items to be verified in the field:
Inspector Name & Date:
Notes
511106 Page 4 of 4
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