HomeMy WebLinkAboutCLE200700288 Legacy Document 2014-04-28Application
Zoning Clear
for
ance
mooning Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
Tax map and parcel: 0_9 C)C)()- 00- OnQ- C)?-,L3--(00 Existing Zoning:_ 46 --CnA ,5,r (
Parcel Owner: U(Ine
Parcel Address: 0(157 sr13WI)1c11)4 Lo, 41 City hnc �o CLt'��� State V zip22g0L
(include suite or floor)
Contact Person (Who should we call /write concerning this project ?): C, Lk, I)-\lien la
Address 1305 Car I +on Aw • City !21-cor pAks'j i l le- State �_ Zip I)-- 0a
Daytime Phone Fax # ( q iIv`Qjq E -mail e (
Business Name/Type:-5 ne- Rld(-A�
Previous Business on this site:
Proposed use: r C"lbr ( CAS ► L3 � CEO -kjn�
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.
Signature of
Print Narne
—� i
Date
APPROVAL INFORMATION
[ ] Approved as proposed [ ] Approved with conditions
] Backflow device and /or current test data needed for this site. Contact ACSA 977 -451' 1, 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 (t I �Z
Zoning Official U Date
Other Official Date
FOR OFFIC UtSF�NLY g j.- CLE # :J ��-' a
Fee Amount $ ' Date Paid By who. C:' - Receipt # ` Ck# By:
County of Albemarle Department of Community Development 6i{
401 McIntire Road Charlottesville, VA 22902 Voice; (434) 296 -5$32 Fax: (434) 972 -4126 5/1/06 Page 2 of 4
'Applicant to complete the following:
Do you have one of the following?
DYES ❑ 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.
Tech to
Violations:
❑ YES ❑ NO
If so, List:
Variance:
❑ YES ❑ NO
If so, List:
the
invaKC LU L:V111P1VtV LIM 1V11Vrr11a V,.
ES ❑ NO give applicant a Certified
Is use m LI, HI or PDIP zoning. If so, g pp
Engineer's Report (CER) packet. A
❑ YESN®
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 [?1<l'6
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
ES ❑ 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. 1
Permit
a[YpBS ❑ NO e f
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
❑ YES
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 ❑ NO
If so, List:
5/1/06 Page 3 of 4