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HomeMy WebLinkAboutCLE200600272 Legacy Document 2014-04-25Application for Zoning Clearance Z DoCp w,,7 74 Zoning Clearance = $35 PLEASE REVIEW ALL 3 SHEETS Tax map and parcel: 0-74e C ©-0 ✓ _00 ~ 00 a 6 Existing Zoning: 6 1-%7�'}� Parcel Owner: Parcel Address: ho-, Z& k"-, r)t": :5/-1'�zb City C4 r Me State V ll�-- Zip (include suite or floor) Contact Person (Who should we call /write concerning this project ?): Address 5 1-6 L to G�2<'v �r �j'r-- � City �'{?/� ��d ���� State Zip ,2 Z- d Daytime Phone % l�2 ✓ ` Fax # (_) � 7�" S �S� E -mail t ` r% (7 Business Name /Type: 34 (C- 14, C r d� -��/� L)4v— Previous Business on this site: Proposed use: W it (/C ct! a le� SEE CONDITIONS OF APPROVAL IF THE CLEARANCE IS FOR FIREWORK OR CHRISTMAS TREE SALES (Sheet 1) Circle (if applicable): Fireworks / Christmas Tree *This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move the use to a new location, a new Zoning Clearance will be required. I hereby certify that I own or have the owner's permission to use the space indicated on this application. I also certify that the information provided is true and accurate to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by -them. /7 Sig- na67re pf Btmness per pr Agent i Date Print Name A fROVAL INFORMATION N/] Approved as proposed [L flow device and /or current test data needed for this site. o physical site inspection has been done for this clearance. [ ] This site complies with the site plan as of this date. ] Approved with conditions Contact ACSA 977 -4511, x119. Therefore, it is not a determination of compliance with the existing site plan. Building Official Date t ( b Zoning Official Date 2 b G Other Official Date FOR OFFICE USE ONLY CLE # 7-004o-a757 Fee Amount$,35100 Date Paid By who? Ale- -K Receipt# Ck# /GO& By: 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 4 e f- A- pplicant to complete the following: Do you have one of the following? i ❑ YES NO Tax Map and Parcel Number and or; Address of use (include unit or floor if appropriate) ❑ YES 66 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. , oning Tech to c Violations: ❑ YES UAO If so, List: Variance: ❑ YES NO If so, List: the 3r�y Intake to complet a following: ❑ YES NO Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's keport (CER) packet. ❑ YES X 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 [ 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 i YES ❑ NO 11s on public water and sewer? ❑ YES Z 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 NO Is this for saes of Fireworks? If so, obtain a copy of F/R permit. Permit # Proffers: ❑ YES [YNO If so, List: SP's: ❑ YES E47O If so, List: 5/1/06 Page 3 of 4 Reviewer to complete the following: Square footage of Use: YES ❑ NO Permitted as: 0-r4c" i Under Section: Supplementary regulations section: `� r6 (y\ Parking formula: 6 / :*0 v 11 , Required spaces: ❑ YES ❑ 0 Items to be verifi d in the field: Inspector Name & Date: Notes 511106 Page 4 of 4