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HomeMy WebLinkAboutCLE200700230 ApplicationTax map and parcel: Parcel Owner: 4 Parcel Address: 1i�J�J11l.L111V11 1V1 Zoning Clearance DKOning Clearance = $35 PLEASE REVIEW ALL -3- SHEETS – — (aI LJ o 03 &o rd -146 [a /, -GL"- ty I �ll(;IN \h Existing Zoning: V' IV 4, (Won 5 u . (fy. State Zip (include suite or floor) Contact Person .(Who should we call /write concerning this project ?): I V ► C ` £- O r Address IqLS PG-rkStde Place -- City S'tgF State ✓ft Zip Daytime Phone 43 rJt� Tax # (� rl0 ?g3 3,,57/0 E -mail n(cc le-e eDcnl 'Business Name /Type: p`) s i 0 Previous Business on this site: LO K:e S k Q kc- Pro ose)l t�se: ,C� G�i e l U41 �'l f'Gt�7�✓" �C5 �f C LSIr rM� C{ ric°Gt 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 ce tfy that I own or have the owner's permission to use the space indicated on this application. I also certify that the information provided Arue an jaccur4e to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide �gnfft#e of BusiMss Owner or Agent K) � cof-e ,9, ,_ 0o�– Print Name a/j�Z��% Date Backflow Device and/or Current Test Data Needed APPROVAL INFORMATION contact 7 -4 11, x 115 [ Approved as proposed [ ] Approved with conditions [Wackflow device and /or current test data needed for this site. Contact ACSA 977 -4511, xl 19. [vfNo 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 a"1 Zoning Official Date it Other Official Date FOR OFFICE USE ONLY CLE # 3 0 % �f r . , X Fee Amount $ Datc Paid �By who? Receipt / U/ / V Ck#� By: E'' County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 5/1/06 Page 2 of4 l n Applicant to complete the following: Do you have one of the following? ❑✓'YES ❑ NO Tax Map and Parcel Number and or; Address of use (include unit or floor if appropriate) 5-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? Tile 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. .,oning Tech to c Violations: ❑ YES ® NO If so, List: Variance: ❑ YES E3 NO If so, List: Mete the following: Intake to complete the following: ❑ YES [!j NO Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. ❑ YES ENO 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 2--NO Is parcel on private well and septic? If so, give applicant it Health Department form. Zoning review can not begin until we receive approval from Health Dept, FAX DATE 2 YES ❑ NO Is on public water and sewer? Eff YES ❑ NO Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. �p Permit # a0D= ❑ YES ❑ NO Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # ❑ YES E-'NO Is this for sales of Fireworks? If so, obtain a copy of F/R permit. Permit # Proffers: ❑ YES U NO If so, List: SP's: ❑ YES © NO If so, List: Squargver to complete the following: Square footage of Use: V D/YES ❑ NO Permitted as: Under Section: Supplementary regulations section: L �/� Parking formula: Cekt+! 2equir d spaces: YES NO Inspector Name & Date: Notes 511106 Page 4 or