HomeMy WebLinkAboutCLE200700093 Legacy Document 2014-04-28ff A&cif=
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Application for Zoning Clearance U.®
OFFICE USE ONLY /� 2
❑ Zoning Clearance = $35 CLE #
PLEASE REVIEW ALL 3 SHEETS Check # Date: L4 -17 -0
Receipt # Staff- M
PARCEL INFORMATION j
Tax Map and Parcel: Q I 0 /v[ O b b O �1-11 O Existing Zoning !� I
Parcel Owner: kaed Pm_ 1- /�!1�1�L✓
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Parcel Address: `� � O � ✓rru>Z9t V • City State � Zip
- - (include -------------------- suite floor)--- -------------- --- - --
APPLICANT INFORMATION s
Who should we call/write concerning this project? (s �c "� '
Address: 460 fl , PJ7 V� City ( 7fGG4) � � State �� f Zip d old
Office Phone: 63f J1'3 - 5449Cell # 531-141
Fax #�`N 173.769% E -mail �L` ���(l�,L`elYl i
- -___R 1 -- A R R---Y ---- - CONT- - - -- -- A --------------------------------------------------------------------------------------------------------------------
PRIMC
Business Name /Type:1l
Previous Business on this site:
Proposed use: L!nl�_ 1"� e 7
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 be f my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signa - "re- l�l `7 Printed
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APPROVA� IN RMATION
[ ] 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.
%4;.
Building Official
Zoning Official
Other Official
Date
Date
Date
& ".r`K� lr.�
--------------------- - - - - -- - - - - - - --
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:
N
ifo 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
ctrncture_
31
D
T
Y/N
If so, List:
the
9/28/05 Page 2 of 4
Intake to complete the following:
Y/N
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/N
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
Y/N
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
Y/N
Is 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/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Y/N
Is this for sales of Fireworks?
If so, obtain a copy of F/R permit.
Permit #
Proffers:
Y/N
If so, List:
Variance: SP's:
Y/N Y/N
If so, List: If so, List: