HomeMy WebLinkAboutCLE200700250 Legacy Document 2014-04-281 1
c Zoning Clearance
❑ Zoning Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
Tax map and parcel.' 0'/ goo °— 00 -
1'11reel Owner: / 111 cr,V t rLCk-- \1U y ✓v ✓�
Pareel Address: kj �1�' �CiDZy" x Pkwj. City
(include Suite or floor) I
Existing Zoning: U' AA
�
/ �/ *11(;
State VA - zip —.
Contact Person .(Who should we call /write concerning this project ?): (� &! �A A r
Address -! '70 a,2 6.-,,,j / zy City State L11f • Zip gigh
Daytime Phmte — E -mail
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.
rmature p, f Bus ness Owner or Agent Date
r&ri 0,< � v�t4
Print Name r Backflow Device and /or
A, RPROVAL INFORMATION
[ Appr ved as proposed
[ ow device and /or current test data needed for this site.
[d No physical site inspection has been done for this clearance,
[ ] This site complies with the site plan as of this date.
Contact ACSA 977 -4511, x 119
] Approved with conditions
Contact ACSA 977 -4511, x 119.
Therefore, it is not a determination of compliance with the existing site plan.
Buildhig Official J.-
Zoning Official I
other Official �J ���1 . ru__ ' °' iii_. `.� 0�
FOR OFFICE USE ONLY CLC# �cao7oa2
Fec Amount $ - % -00 Date Paid Id-5-0 By who? K m l� '.e 1. e ie,�4 Receipt it 0 ;V4110 Ckfi. By: 7-0jd
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 5 /1/o6 Page 2 oF4
?Applicant to complete the following:
Do you have one of the following?
n YES Q'NO
Tax Map and Parcel Number and or;
Address of use (include unit or floor if appropriate)
IdYES ❑ 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?
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.
1-13a
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57-6 f�j
ZoninLy Tech to
Violations:
❑ YES &?NO
If so, List:
Variance:
❑ YES QI-NO
If so, List:
the
1111UKe LU C%UlilpleM Lilt: 1U11UYYlllg-
7 YES ❑ NO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
En
ineer's Report (CER) packet.
7YES ❑ 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 D / '.
❑ YES VNO
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
YES ❑ NO
Is on public water and ser?
11 YES ❑ NO
Will you be putting up a new sign of any kind? If so, obtain
proper Sign permit• re t.4 Ld �Inllj .
Permit #
❑ YES NO
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit # _
❑ YES NO
Is this for sales of Fireworks?
If so, obtain a copy of F/R permit.
Permit #
Pro ers:
YES ❑ NO
SP'
[V YES ❑ NO
If so, List:
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