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HomeMy WebLinkAboutCLE200700206 Legacy Document 2014-04-251-1�J1J111.Q L1V 11 1V1 ��sl� ' /�.' �> Zoning Clearance ❑ Zoning Clearance = $35 PLEASE REVIEW ALL 3 SHEETS Tax map and parcel; TP11 V, fi' Existing Zoning: "iz /_XF rc i4 R{ wcl Parcel Owner: r Parcel Address: 3ZS- Fc�l d-r � t,I �© City C ACS �l J X51%7 I , F State W� Zip :22r103 (include sulte or floor) Z� 10 o n or Contact Person (Who should we calllwrite concerning this project ?): J Address 8a< 3,9 - 2o-) C�rnzd Ave city &oz I State �Q Zip 22�3Z Daytime Phone (W) '32 Fax # (%34 2? - 22-91 -2, E-mail t l��'�� fa � Dll j1IJAleil/ , C&I-1 Business Name /Type: �!`S 1 C.C.' Y`� 1 CSC' /J�U'i' �a lGj G !J(a rG?' / �s Previous Business on this jsite: Iyyl\., . Proposed use: d-e- A1]'Q/ J 0 W. - fit' 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 abi by them. J�,O, Idt'6.0.0's y _,2 Si ature of Business or Agent Date ` Print Name _ AOVAL INFORMATION `'"`renit Test Data heeded intact A Approved as proposed [ ]Approved with conditions C3A 977.4511, g 119 ] Baekflow 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 or compliance with the existing site plan. ] This site complies with the site plan as of this date. Building Official Zoning Official Other Official Date s.hsa o Date Date FOR OFFICE USE ONLY CLE #_ �0 C% �� //'` / y Fee Amount $� Date Paid " ?Y who? 1 I �� Reeeipl fli!>' l� (��o 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 ot'4 11 k �.._ Applicant to complete the following: Do you have one of the following? YES F] NO Tax Map and Parcel Number and or; Address of use (include unit or floor if appropriate) x 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. �� CO- Tech to complete the foll Violations: ❑ YES NO If so, List: Variance: ❑ YES ❑EKNO If so, List: Intake to corn lete the following: ❑ YES NO I Is use in Li, xii, or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. ❑ YES ; there e kN 0 d preparation? If so, give applicant a Health Department form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE ❑ YES r� NO Is parcel of 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 i public water and sewer? A iYES ❑ NO 1 you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # ❑ YES NO Will there 'A e any new construction or renovations? If so, obtain the proper Permit. Permit # ❑ YES' NO Is this for s of Fireworks? If so, obtain a copy of F/R permit. Permit # ❑ YES ❑ NO If A, Lists q uu- is It -~ ,t� Y --\ SP' FYES ❑ NO If so t:� Reviewer to complete the following: �I(a► Square footage of'Yse; ES ❑ NO errmtted as; Under Section; (t � .2,� • �2c Supplementary regulationsiis``ectiion: a Parking formula: r— Required spaces: ❑ YES ❑ NO Items to be verified in the field: ?�0 Inspector Name & Date: Notes 511106 Page 4 or4 iq 4.