HomeMy WebLinkAboutCLE200700278 Legacy Document 2014-04-28Tax map and parcel:
Application for
Zoning Clearance
Zoning Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
_5
Parcel Owner: V l rg i wt C1 L&.,. c( —Fe—,,
Existing Zoning:
Parcel Address: lee'? 0/ /tG-,% /SO¢C/ City C_ -�Qf� dSy�oState ✓/� Zip 2Z294/
(include suite or floor)
Contact Person (Who should we call/write concerning this project ?): Jf°(I�LrI Wl. IUI, C R Address �. D. Bdy �iLP City (SCW1c; I®sV; Me State 04 Zip 225'a
Daytime Phone ( /�11 Q%Q- g��� Fax #y4Y)a9( 31;10 E- mail_V�S �LTD/�i(�%{OL.CONti
Business Name/Type:
_ r n
Previous Business on this site: H(yt -,�M L. L�M1C, i r�L°'ei &s 4 J U.ryi!7 j KS
Proposed use: i�t�it°n� Ives, e tot t a
I I (e, 1 A P c
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.
1 hereby certify that 1 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
labi b t em.
- Nei , 1?, 20o7
Signatu e of Business Owner o gent Date
Print Name
APPROVAL INFORMATION
M Approved as proposed [ ] Approved with conditions
[ "],Backflow device and /or current test data needed for this site. Contact ACSA 977 -4511, x119.
[� 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 Date 11 )
Zoning Official Date 44
Other Official Date
FOR OFFICE USE ONLY C L E # tQ6 6)7 >Oc?7
Fee Amount $ :2rj �Yii Date Paid % g By who? ,_ L � Receipt # Ck #�� By: V �
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
S it
Applicant to complete the following:
Do you have one 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.
lg�y
Zoning Tech to com
Violations:
❑ YES NO
If so, List:
Variance:
❑ YES [ NO
If so, List:
the
Intake to complete the following:
❑ YES ONO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
❑ YES [P ENO
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 �IO
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?
❑ YES RNO
Will you be puttmF up a new sign of any kind? If so, obtain
proper Sign permit.
Permit #
❑ YES [> (T
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
❑ YES [1NO
Is this for sales of Fireworks?
If so, obtain a copy of F/R permit.
Permit #
Proffers:
❑ YES ®'NO
If so, List:
SP's:
❑ YES 91—No
If so, List:
511106 Page 3 of
Reviewer to complete the fol_lo}vi :
Square'footage of Use: (�f (�
6/YES ❑ NO
Permitted as: I-WOU 4-'Q�CCe-,
Under Section: M • 01" ( , a-$'
Supplementary regulations section: VI (01
Parking formula: ((cam Q Vk-PQ
Required spaces: S
❑ YES ❑ NO
Items to be verified in the field:
Inspector Name & Date:
Notes
5/1/06 Page 4 of