HomeMy WebLinkAboutCLE200700232 Legacy Document 2014-04-281 1
Zoning Clearance '"
/ MHAV,
oning Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
Tax nrap and parcel; iJ �C / / T Existing Zoning:
Parcel Owner:
Parcel Address: '( 0 1Ckc i t°. City �S w% I C `�- State Zip 9aj`I
(l►►elude suite or floor)
Contact Persoa,(Who shotdd we call /write concerning this project ?):
I/�
Address_��I4 SvASt �� City ��D�(10 yi`�2 State /VA Zip X-9 O3
Daytime Plione.(L ") USQ - .300'3 rax_ #.( —).: E -mail
Business Name /Type: y , �vkc
Previous Business on this site:
Proposed use: w e 1C r ~ �y-o n �
,c; C_,-Ay 0 f\
SEE CONDITIONS Or 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.
s� -18 —��
Signature of Busiht4s Owner or Agent Date
ufi Ilia
Print Name �—
APPROVAL INFORMATION
[ ] Approved as proposed [ ] Approved with conditions
] Backfiow device and /or current test data needed for this site. Contact ACSA 977-4511, x 119.
] 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
Date
Zoning Official
Date
Other Official _
Date
FOR OFFICE USE ONLY CLE # _
Fee Amount $ 15 09 Date Paid 9 143'07 By who? �A M.C` Re�ecp� C
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) .296 -5832 Fat: (434) 972 -4126 5/1/06 Page 2 of4
Applicant to complete the following:
Do you have one of the following?
YES ❑ NO
ax Map and Parcel Number and or;
Address of use (include unit or floor if appropriate)
YES ❑ NO
o you nave 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.
coning Tech to c
Violations:
❑ YES ❑ NO
If so, List:
Variance:
❑ YES ❑ NO
If so, List:
the
1nTMICC 1.0 C0111PIeae LIM tuiluvriiib:
❑ YES P NO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Reeport(CER) packet.
❑ YES U11, t(
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 ❑ NO
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?
❑ YES FT'rN 0
Will you be putting up a new sign of any kind? If so, obtain
proper Sign permit.
Permit #
❑ YES NO
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
❑ YES [g /NO
Is this for sales of Fireworks?
If so, obtain a copy of F/R permit.
Permit #
Proffers:
❑ YES ❑ NO
If so, List:
SP's:
❑ YES ❑ NO
If so, List:
Square footage of Use:
❑ YES ❑ NO
Permitted as:
Under Section:
Supplementary regulations section:
Parking fornulla:
Required spaces:
❑ YES ❑ NO
Items to be verified in the field: _
Inspector Name & Date:
Notes
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