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HomeMy WebLinkAboutCLE200700290 Legacy Document 2014-05-06Tax map ai Parcel Owr Parcel Add Application for Zoning Clearance m I �ItCIN�'� ❑ Zoning Clearance = $35 .� PLEASE REVIEW ALL 3 SHEETS V 1 (include suite or floor) Contact Person (Who should we call /writevconccerning this project ?): a r Address e 6 )B p' 6 � / yJ_ City. State 0 - Zip Daytime Phone Fax # E -mail IV-4adji Al �1 Y' ME Business Name /Type: Previous Business on this site: Vo �,t Ai 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. I Lao C) Wna ure o Busine Owner or Agent Date Print Name APPROVAL INFORMATION [ �] Approved as proposed [ VJ Approved with conditions [ ] $ackflow device and /or current test data needed fm this site. Contact ACSA 977 -4511, x119. [VI 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 cgmplies with the(sip plan as,of� his dale. v .--- Building Official a- Date I a-I Zoning Official Date 12 ; 6'r Other Official Date FOR OFFICE USE ONLY CLE # - ab0'7,9Ug q. 0 Q �-- Fee Amount $ 'j -60 Date Paid j/ a� By who? �j �-l� SReceipt # 60 1 /'l Ck# ��3 By: 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 a Applicant to complete the following: Do you have one o 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. -- �� R , oning Tech to/e/ Violations: F-] YES � ✓ NO If so, List: Variance: / ❑ YES NO If so, List: the 1nLaKe 1U 1:U111P1GLG L11c 1UUVrr1116. ❑ YES ❑ NO Is use in LI, HI or PDIP zoning? Engineer's Report (CER) packet. If so, give applicant a Certified ❑ 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 ❑ NO Is parcel on private we 1 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 ❑ NO Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # [I YES ❑ NO Will there be any new constr ction or renovations? If so, obtain the proper Permit. Permit # ❑ YES ❑ NO /L1 Is this for sales of Fireworks. If so, obtain a copy of F/R permit. Permit # Proffers: ❑ YES E NO If so, List: SP's: ❑ YES ©NO If so, List: 5/1/06 Page 3 of 4 Reviewer too/ complete the Millowing: Square�fo • iage of Use: 1, YES O -- Permitted as: XJV AEI Under Section: ��� ►��" , Supplementary regulations section: Parking formula: W � A Required spaces: ❑ YES ❑ NO Items to be verified in the field: Inspector Name & Date: Notes 5/1/06 Page 4 of 4