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HomeMy WebLinkAboutCLE200700287 Legacy Document 2014-05-06Application for Zoning Cle�ance' F "'r %ROIN Lv�7oning Clearance = $35 PLEASE REVIEW ALL 3 SHEETS Tax map and parcel: D Y5 C ® 3 ' M —0" 0, Existing Zoning: Parcel Owner: J,-) c) d Cl 4 o y`-,- Parcel Address: q ;L0 6 �- U-�COO t3�Vil. Ssi o City C' t.c-! 1% Hct,_'V( i / e— State VC., Zip �� 2 (include suite or floor) Contact Person (Who should we call /write concerning this project ?): a'rC Address -7 9-Y City y rC,� State VC1,_ Zip Daytime Phone /; - / I'�S Fax # L__) E -mail Business Name /Type: Previous Business on this site: A) Proposed use: 6 f-6 e_ 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 tola 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_iiggn�atttA of Business Owner or Agent Date Print Name Backflow levier and /or APPROVAL INFORMATION I Current 1 est L;aia neeueca pproved as proposed [ ] Approved with conditions Contact ACSA 977- 4511, x 119 [ ] Backflow device and /or current test data needed for this site. Contact ACSA 977 -4511, x119. [ ] No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance,with the existing site plan. [,,] -Yids site complies with the site plan as of this date. Building Official Date i I t 9`1 Zoning Official / eb Date Other Official Date It FOR OFFICE USE ONLY -7 CLE # 200-7— a S '7 sp n Fee Amount $ 35, pO Date Paid 1 i'I g By who? Tcx -Ict N ee-i ho m Receipt # !n V3 7 9 Ck# 00S h By: U1� 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 of 4 Applicant to complete the following: Do yq�have one of the following? YES ❑ NO Tax Map and Parcel Number and or; Address of use (include unit or floor if appropriate) ❑ 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? 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. OfIlly ina Tech to com Violations: ❑ YES If so, List: Variance: ❑ YES E"NO If so, List: the a ;P% 1niaKe Lu L:uiupi - 11161V11vrriiav,. ❑ YES lU Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. ❑ YES ail � 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 ISO 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 2 NO Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # ❑ YES E?RO Will there be any new construction or renovations? If so, obtain the proper Permit. QQ Permit# .7 F72oo ?_tcf 9Y1%G ❑ YES (y N0 Is this for sales of Fireworks? If so, obtain a copy of F/R permit. Permit # Proffers: , , ❑ YES P71 NO If so, List: SP's: �' F-1 YES ©NO If so, List: 5/1/06 Page 3 of Reviewer to complete the fgllo g: Square of Use: f( (( )) [❑i YES ❑ AQU Permitted as: Under Section: �' a ` Supplementary regulations section: l��l Parking formula: 1 1Ji)bn Recluir d �' " spaces: "YAM _r` YES ❑ NO Items to be verified in the field: Inspector Name & Date: Notes 5/1/06 Page 4 of 4