HomeMy WebLinkAboutCLE200700203 Legacy Document 2014-04-251WF"%,Q. L1 V 11 -tux
Zoning Clearance
❑ Zoning Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
Tux map and parcel: 4 0 to 0 U6_ � existing Zoning:
(include suite or'ifoorP
Contact Person .(Who should we call /write concerning this project ?) :, l )
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Address N3 l�! P� City State Zip
Daytime Phone Fax # C__j E-mail -
Business Name /Type:
Previous Business on this site:
Proposed use:
511
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I %IMIN�N`
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.
l- & 7
Sig tureeoof Business Owner or gent D e
Print Name
071,x- j1 F
APPROVAL INFORMATION
[ ] Approved as proposed �P"'] 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 J. P �— Date at- �
Zoning Official _ Date 3 Wb7
Other Official Date
FOR OFFI NLY C #
Fee Amount $t� Date Paid OtBy who? Q — Receipt 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 of
1, Applicant to complete the following:
Do you have of e 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.
Zoning Tech to c
Violations:
❑ YES —
If so, Li :
Variance:
❑ YES�eNO
If so, List:
the
Intake to complete the following:
❑ YES 4 NO
Is use in LI, HI or PDIP zoning? If so, give applicant a Ce
Engineer's Report (CER) packet.
❑ YES �'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 Dept.
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
OYES ❑ 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 i NO
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
❑ YES d NO
Is this for sales of Fireworks?
If so, obtain a copy of F/R permit.
Permit #
Proffers:
❑ YES ,Z NO
If so, List -"
SP'
YES ❑ NO
If so, List:
�z Zy
�-
4S
rtified
tv
Reviewer_to complete the following:
Square footage of Use:
r,
YES ❑ NO
Permitted as:
Under Section: 4JAi n ,i2 r'01c.T ) CG_
Supplementary regulations section:
Parking formula: 1AW 4.401, k �
_ - -�
Required spaces:
❑ YES E NO
Items to 4 verified in the field:
Inspector Name & Date:
Notes
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