HomeMy WebLinkAboutCLE200700270 Legacy Document 2014-04-28a
A 1
Zoning Clearance
Zoning Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
R11".111
Tax n►ap and parcel' (.. Existing Zoning:
Parcel Owner: ,,ag !f1:21- �/ //�
Parcel Address: b "� prj My City � 4' I B10.SVI �+� State �� Zip 22!
(inchtdc suite m' floor) �,y�,{ -a. /+Jp� �
7
Contact Persout.(Who should we call /write concerning this project ?): C j •ezIAm I
Address
�'r/ S S�n�/ i�C> %�/'�r � City rx�d/l> /f State O Zip A9 1?0
.Daytime Phone ('� _ ���� ° G�,�7� Tax .# 'K-31 — QZQ .E -mail
Business Name /Type: A Fj n 1114
4 4e ' --c
Previous Business on this site:: Alk.,/
Proposed use: Ttb! � X I
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.
Sign re f Owne' or Agent Date
Print Name
APP OVAL INFORMATION
[ pproved as proposed [ ] Approved with conditions
Bacliflow Device and /or
[ ] Backflow device and /or current test data needed for this site. Contact ACSA 977 -4511, x 119. Current Test Data Needed
[ ] No physical site inspection has been done for this clearance. Therefore, it is not a determination of complian e wtRWA611A10, 143.11, x 119
[ ] This site complies with the site plan as of this date,
Building Official sA Date it
Zoning Official Date 1 1
Other Official Date
FOR OFFICE USE ONLY CLG it J,09 7 d 70 / ��
Fee Amount S cl!)z Date Paid 0 By who? • _ r . z �_ Receipt 11 {C� � /a7 Ck# By:
rn„nty of Alhpmnrle Department of Community DevelOnment
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 5/1/06 Page 2 oF4
Applicant to complete the following:
Do you have one of the following?
� YES ❑ NO
ax Map and Parcel Number and or;
Address of use (include unit or floor if appropriate)
k 'ES ❑ NOu have a Floor Plan (sketch or an architectural drawing) that
es 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.
Soning Tech to
Violations:�
❑YES [�"N
If so, List:
Variance:
❑ YES VNO
If so, List:
lete the
jn1HKe LU cutup to LIM iulluwiiig:
❑ YES NO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's ;�:O-
Will R) packet.
❑ YES 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 ATE
❑ YES a 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?
IYS ❑ NO
Will you be putting up a new sign of any kind? If so, obtain
proper Sign permit
Permit #
ET"YES ❑ NO
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
❑ o YES � G
Is this for sales of Fireworks?
If so, obtain a copy of F/R permit.
Permit #
Proffers: ^/
[] YES L- - O
If so, List:
SP's:
❑ YES [/NO
If so, List:
Square footage of Use:
IV I
Pe Y S N1 i (kv� 5�5
Per tted as; �
Under Section:a
S LIPP I ementary regulations section: _�
Parking formula;
Requi
❑AES ❑ MO
Items to be verified in tl feed:
Inspector Name S Date;
Notes
511106 Page 4 oN