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HomeMy WebLinkAboutCLE200700216 Legacy Document 2014-04-25Application for Zoning Clearance I� oning Clearance = $35 PLEASE REVIEW ALL 3 SHEETS Tax map and parcel: 6(0 �� " ®� ��a Existing Zoning: '�.�ry) C Parcel Owner: �,:) t • zip Parcel Address: �(`� Qt�rK�,n w� - - Cr,Stn� ity C �11�� ��l ► Ut ljf State b),_ b),_ r :961 (include suite or floor) Contact Person (Who should we call /write concerning this project ?): Or tY1a MQCC6_& i Oi 9' K4 c./ MC(_ Address ��C1) lzt f1iYe�w City AV� U�St�t'CE'Statc �� Zip��e� - - - -- - -- - - - -- f tC `ifi � f r Daytime Ptf e �i �3 �� 53C) Fax # (_� E -mail �8 Q, Business Name /Type: F �u )?- � /_ l0,/) Previous Business on this site: t-{ sa_( o1 Proposed use: UQ-1 1- _•�5a� ` 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 ot Business Uwner or Agent Print Name 8P"OVAL INFORMATION Approved as proposed ] Backflow device and /or current test data needed for this site. ] No physical site inspection has been done for this clearance. ] This site complies with the site plan as of this date. Building Official Zoning Official Other Official P) Date [ ]Approved with conditions " ""�-- -- -- •r..�..■,,,,�„�, Contact ACSA 977 -4511, x1 19. [BackflowDevice;andjor urrent Test DataNeeded Therefore, it is not a determination of comp( >tN1MIAe �M15 4 ti, X 119 Date Date Date FOR OFFICE USE ONLY CLE # _204D-1 167 Fee Amount $,13 j',0 0 Date Paid 44, Z§-Vi By who? Receipt// Co7b-j!T 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 Paget of `Applicant to complete the following: ;�O"ES• eve one of the following? S ❑ 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. )) 00 �Sb, 4-t Tech Qcomplete the tFVET ❑ NO If so, Lis / r 12 Variance: ❑ YES 6NO If so, List: Intake to ;.;No 0 ple -he following: F77 YES Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. ❑ YES B 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 F-1 YES K 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 © YES ❑ NO Is on public water and sewer? ❑ YES 0 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 # ❑ YES ©-N!U 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 NO If so, List: � 4 -(:) '�) Lo u r\ �� I SAC ©o�