HomeMy WebLinkAboutCLE200700265 Legacy Document 2014-04-28L i
Zoning Clearance
❑ Zoning Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
Tax map and parcel: D / C /C� —00-00— 096CO Existing Zoning:
V VA Ik �-
Parcel Address: ess: 1 �-O e "�- City /h✓��`�S1i `� State Zip G % C
(include suite or floor)�/�
Contact Person .(Who should we call /write coneeruing this project ?):
Address �q City
Daytime Phone
Business Name /Type:
Previous Business on this site:
Proposed use:
E -mail
State Zi
2M
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 beast of my knowledge. I have read the conditions of approval, and I understand them, and that I will
nhirle by them.. \ /\ n I 1
Si2n6the of Business Owner or Agent
Print Name
_ 10) � --
Date
AP ROYAL INFORMATION
Approved as proposed [ ] Approved with conditions
[ ] Backilow 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 c um Date 1 z 6a
Zoning Official ,,, Date
Other Official Date
FOR OFFICE USE ONLY 077 CLG # 07' L ' q f�
Fee Amount $ 8,5,00 Date Paid OA9 By who? Receipt it oo(o Ck�{ !T By, i
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 of4
I Applicant to complete the following:
Do you have one of the following?
OYES ❑ NO
Tax Map and Parcel Number and or;
Address of use (include unit or floor if appropriate)
❑ YES,,E'NO
Do you haven Floor Plan (sketch or au 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.
a
Zoning Tech to
Violations:
❑ YES/ NO
If so, List:
Variance:
❑ YES 'NO
If so, List:
the
inLalce 1.11 CUMPIMC LIM tuituvrliib:
❑ use 0
Is use in L , HI or PDIP zoning?
Engineer's Report (CER) packet.
❑ YES NO
If so, give applicant a Certified
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 o1 hate 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
on public water and sewer?
❑ YES NO
Will you b*tput ng up a new sign of any kind? If so, obtain
proper Sign permit.
Permit #
❑ YES 0
Will there Vay ne w construction or renovations?
If so, obtain the proper Permit.
Permit #
❑ YES�O
Is this for s``alesbbf Fireworks?
If so, obtain a copy of F/R permit.
Permit #
Proffers:
❑ YES NO
If so, Lisx.
SP's:
,❑/`YES ❑ NO
If so, List: �2
Square footage of Use:
❑ YES ❑ NO J
Permitted as:
Under Section:. � ,� �,� I2Kq I �"� e- k-
Supplementary regulations section: I
Parking formula: el
J
Required spaces:
❑ YES EJN`O
Items tc e verified in the field:
Inspector Name & Date:
Notes
511106 Page 4 or4