HomeMy WebLinkAboutCLE200700225 Legacy Document 2014-04-25Application for
r
Zoning Clearance
Q Zoning Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
X512
1 /IiCIN�P
Tax map and parcel: �D / _ 43 Z Existing Zoning.-MMI
Parcel Owner:
Parcel Address: �I V�-1 F � City 1 r 1) I Y�I State Zip L�
(include suite or floor)
Contact Person (Who should we call /write concerning this project ?): /k / 1
Address ���% C/ City �,(rt4 -ik)i (fl � f State �� Zip
Daytime Phone �t �� t�%D� Fax # // /���p %� E -mail
Business Name /Type: ,til V�
Previous Business on this site:
Proposed use: c���� `�M f — ��7 %r.) `'� ` e,
T�
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 be of my knowledge. I have read the conditions of approval, and I understand them, and that I will
abide by them. , /
Sig gre%of Business Owne/or Agent
Print
�i b
Date
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 Date
Zoning Official ,�^ ` Y _ s` .. Date 'yZ/1 6 7
Other Official Date —_�
FOR OFFIC 1 USE ONLY �i CL
,c #
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 Page2 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 4NO
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.
Tech to complete the
Violations:
YES ❑ NO
f so, List: 2-a6-7
Variance:
❑ YES,-F-f NO
If so, List:
Intake to c the following:
❑ YES O
Is use in LI, HI or PDIP zoning? If so, give,applicant a Ce
Engineer's Rep rt (CER) packets
❑ YES ' ,.
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. F`,kk DATE
❑ YES
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
jYES ❑ 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 rmit c
Permit # 0d
❑ YES NO
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
❑ YES IiNO
Is this for sales of Fireworks?
If so, obtain a copy of F/R permit.
Permit #
Proffers:
❑ YES Z NO
If so, List:
SP's:
❑ YES ❑ NO
If so, LisK
rtified
C /11 L- - -I -IA
lriz,
LV
'0 Y-CV
Ak
, 11A,
N
y.
Lai,:
t k iAR
th�
31
1
UVO.
Ai.lh
aV
fj�� I — BMWs
'Af
n
�tb
®R,