HomeMy WebLinkAboutCLE200700096 Legacy Document 2014-04-28Application for Zoning Clearance® m
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oning'Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
PARCEL INFORMATION
OFFICE USE ONLY
CLE#
Check # `4909 Date: LJ - % Y- 07
Receipt # 4(o-6- / Staff:
Tax Map and Parcel: 0q 5co —0 Z" 040 100 / 0 0 Existing Zoning 14 L,,u-y (I en
Parcel Owner: %i- o_ C
Parcel Address: City State Zip
(include suite _or floor)_ -_
APPLICANT INFORMATION ��''`
Who should we call/write concerning this project? C., �fv
Address : %�e''! %h�
���i / City � . /!ry u'�/ iP State � Zip
Office Phone: (yA ) x'73 -- 0/1 Cell # S3l -; iy" Fax # % <- 5�c� E -mail ,�Gi�✓'���? %� `ia�, �.
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PRIMARY CONTACT R-_U� ry Business Name /Type:
Previous Business on this site: 0,---7 1
Proposed use: ��]���� ��✓'P_. — _Q_�k— Sa_u
M rx-u 7 i-, 7 e) n -7
Circle (if applicable): Fireworks / Christmas Tree - y,,,q 'v
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 ormove 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 o y Oowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature �� Printed
AJ�PROVAL INFORMATION
Approved as proposed [ ] Approved with conditions
[ ] 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
Zoning Official
Other Official
Date y I la 0°1
Date yl Z310 7
Date
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County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
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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 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.
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Tech to complete the
Violations: .
/ N
so, List:
IAA144 /01�
to r,.
Vari ce:
Y /V
If so, List:
Intake to complete the following:
Y
Is I, HI or PDIP zoning?
Engineer's Report (CER) packet.
9/28/05 Page 2 of 4
If so, give applicant a Certified
Y(N Wi threbe 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
Is p cel 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
on public water and sewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain
proper Sign permit.
Permit #?� y? Zy ? %Mp
Y (N�
Wil ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Y
Is or sales of Fireworks?
If so, obtain a copy of F/R permit.
Permit #
Proff s:
Y /
Ifs st:
SP's:
Y /S7
If so, List:
Reviewer fo complete the following:
Square footage of Use:
L N
Permitted as-
Under Section: ���%MiAJ , ®1rAG�t GQ,
Supplementary regulations section:
Parking formula: y; �c. Q lg,✓
Required spaces:
Y
Items to be verified in the field:
Inspector Name & Date:
Notes
Y//-d/v:) raze .s of 4
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