HomeMy WebLinkAboutCLE200700099 Legacy Document 2014-04-282
Application for Zoning Clearance
`,RGINIP
OFFICE USE N Y
Zoning Clearance = $35 CLE #
PLEASE REVIEW ALL 3 SHEETS Check # M.J. Date:
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel:
Parcel Owner:
Existing Zoning kT-
Parcel Address: IAQVV\p� It - City , Q State Zip
(include suite or floor)___ _______________________ /
- ----------------------------- - - - - -- --
- - -- -----------
APPLICANT INFORMATION
Who should we call/write concerning this project? lFOU4,f
Address : P -6. NP663 City (24ARt,6V5(11U_4 State
V4
zip ZZYd-6
Office Phone: 65�6 y- 377 Cell # Fax # E -mail Rol! •sTocK,�tkuSCuJ p CP�Rc .Caw•
------------------------------------------------------------------------------------------------------------------------------------------------
PRIMARY CONTACT .
Business Name /Type: WA+tt.4ta�
Previous Business on this site: Woe-
Proposed use: (, 00092. 64&Nb 145-TO( &-060 C ;Wr9t_
Circle (if applicable): Fireworks / Christmas Tree
SEE CONDITIONS OF APPROVAL IF THE CLEARANCE IS FOR FIREWORK OR CHRISTMAS TREE SALES (Sheet 1)
*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 of y k owled - av ead the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed /1,r� /���+At- ��•i/l
- ----------------------------------------------------------------------------------------
-----------
-- - - -- --------------------
.
APPROVAL INFORMATION Rftvo w Device and/or
[ ] Approved as proposed [ �pproved with conditions Conv Test Data Needed
Contact ACSA 97
[ ] No physical site inspection has been done for this clearance. Therefore, it is not a determinat 1 t�
site plan.
[
]T sit coruplies with the site as of this Oate. O
Building Official Date
Zoning Official Date /lP /Q
Other Official
Date
------------------------------------------------------------------------------------------------------------------------------------------------
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Applicant to complete the following:
Y/N
Do you have one of the following?
Tax Map and Parcel Number and or;
Address of use (include unit or floor if appropriate;
Y/N
Do you h e a �Floor-Plan ketch o r an architectural drawing) that
includes the o 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 complete the
Violat' ns:
If /
If so, ist:
Vari ce.
Y/
If so, List:
9/28/05 Page 2 of 4
Intake to complete the following:
Y J/ N
use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y
Willem 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
Y 1
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
%/ N
on public water and sewer?
Y / fi)
Will you be putting up a new sign of any kind? If so, obtain
proper Sign permit.
Permit #
Y/N
Will there be any new construction or renovations?
If so, obt V*e o er Pe it. Permit # �ooG - a-72 N C.
Y /
Is this or sales of Fireworks?
If so, obtain a copy of F/R permit.
Permit #
Proffers:
Y /M9
If so, ist:
SP's:
Y Oist:
Ifs
Reviewer to complete the following: �,
Square footage of Use: S 000
Permitted as: t�r��l0 (,�,d.t �l ��� bl Gt7f i Z3Yl
Under Section: Alm ('7
Supplementary regulations section:
Parking formula: 1,600 OO pt
Required spaces: YX t Su , h Ild�
Y/N
Items to be verified in the
Inspector Name & Date:
Notes
7 /La /VJ race 3 OI 4
rage ,+ or 4