HomeMy WebLinkAboutCLE200700091 Legacy Document 2014-04-28Application for Zoning Clearance
`�RGINIP
OFFICE USE ONLY
❑ Zoning Clearance = $35 CLE # 0%00r% — qi I
PLEASE REVIEW ALL 3 SHEETS Check # Cg,S h Date: L/ / 70 7.
Receipt # IASI L3. Staff: 5M ,
PARCEL INFORMATION
Tax Map and Parcel: t �' — ,C�� Existing Zoning P��
Parcel
Parcel Address:UJC O(? R. RD Q8 , City l ,kn &ffi yY I IL State �/ Zipz --j1
(include suite or floor)
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APPLICANT INFORMATION
Who should we call /write concerning this project?
Address PV_Pvg�%y � V64 ZiP�'.L /
Office Phone: (� / Cell #
Fax #
E -mail
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PRIMARY CONTACT rn
Business Name/Type: _ ..�
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 e 4bb t of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
, II
Signature 5)ma4L Printed ,p dl
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APPRO- L VA IN- FO- - -- R- MA- TION
j/] 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
Date y�Z y�� 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
Applicant to complete the following:
Y /)
Do you have one of the following?
Tax Map and Parcel Number and or;
Address of use (include unit or floor if appropriate;
Y /NN
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.
X1 ti ,
�oSK
kaa- ry-,akL Lease
pro, 5 - NzW
, oning Tech to
Violatiions:
Y /(N 7
If so,—List:
Y
If
the fo
Intake to complete the following:
Y/6
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
9/28/05 Page 2 of 4
If so, give applicant a Certified
Y /
Will ere 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 /
Is p el 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 Wil Pyou
be putting up a new sign of any kind? If so, obtain
proper Sign permit.
Permit #
Y /
Will the e be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
YON
Is r sales of Fireworks?
If so, obtain a copy of F/R permit.
Permit #
Prof s:
Y/N
If so, List:
SP's:
Y /�
If so, List:
Reviewer to complete the following:
Square footage of Use: C � �
N
fitted as: ✓'Cf4� / -14 lee-
Under Section:
Supplementary regulations section:
Parking formula:�is
Required Braces: —T
Y N
Ite o be verified in the field:
Inspector Name & Date:
Notes
7ia01w rage.) of 4+
:3/2-8 /UJ rage 4 or 4