HomeMy WebLinkAboutCLE200700231 Legacy Document 2014-04-28I@
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Zoning O prance
[WZoning Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
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Tax map and parcel: 64500 " o "®0"- (5��1 / � Existing Zoning: _
Parcel Owner: I `►' BPn� �41 70;4
Pareel Address:) /� CIO kL, CO)-m4?- City OH le. State Zip
(include suite or flooI')
Contact Person .(Wl►o should we call` /write concerning this project ?): lie-Q).noW
Address 11Dq ksgL tom/ City /%Ili State U Zip 11963\
Daytime Phone, (L IN . �U C�b-i"� ✓c \" i Q�U6 o Cam \
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Business Name /Type: i•Q O I CCA 6 �" ►)'� �� t1 S �bM u`
r r
Previous Business on this site: ` J b _
Proposed use:
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 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 of my knowledge. I have read the conditions of approval, and I understand them, and that I will
abide by them.
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Sign4tu e, of Busin s Owner or Agent Date
1peol,;-7ao ACt���s
Print Maine
AP ROYAL INFORMATION Lurrent Test Data p�w�
[ Approved as proposed I I [ ] Approved with conditions CorlkaCt ACSA 97"j -4S1
[' ] Backflow device and /or current test data needed for this site. Contact ACSA 977 -4511, x 119.
[ ] No physical site inspection has been clone for this clearance. Therefore, it is not a determination or compliance with the existing site plan.
( ] This site complies with the site plan as of this date.
Building Official Date Z v°
Zoning Official Date _9t
Other Official Date
FOR OFFICE USE ONLY CLG # Z00 7—a3 i
Fee Amount $ 5_3 ,D° Date Paid J� q O'7By who? Receipt 497e?-711 Ck{1l=�— By. i
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) .296 -5832 Fax: (434) 972 -4126 511100 Page 2 of 4
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)
BYES ❑ 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 tine 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
Violations:
❑ YES ❑ NO
t
lete the
intaKe Lu cuiupieLe yiie iuiiuvriiib:
❑ YES NO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certi
Engineer's Report (CER) packet.
❑ YES ❑/NO
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�0
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
YES ❑ NO
Is on public water and sewer?
[A YES ❑ NO
Will you be putting up a new sign of any kind? If so, obtain
proper Sign permit,
Permit #
❑ YES DINO
Will there be any new construction or renovations?
If so, obtain the proper Permit, .
Permit #
❑ YES 4NO
Is this for sales of Fireworks?
If so, obtain a copy of F/R permit.
Permit #
E( YES ❑ NO
If so, List:
n?CYS3 �K
Variance: SP's:
❑ YES 0 ❑ YES
If so, List: If so, List:
fed
Square footage of Use:
2—f 5S—/❑ N
Permitted as:
Under Section:
Supplementary regulations section:
Parking formula:
Required space
❑ YES ❑ NO
Items to be verified in the field:
Inspector Name & Date:
Notes
511106 Page 4 or4
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