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HomeMy WebLinkAboutCLE200700293 Legacy Document 2014-05-06Application for Zoning Clearance ❑ Zoning Clearance = $35 PLEASE REVIEW ALL 3 SHEETS Tax map and parcel: 62/00 -ego -Ob -- 6"14 6 d Existing Zoning: ffJ / Parcel Owner: �_G C_c s�tAa - orb A G- C. Parcel Address: �t 4A !9,wa kL ©f',JTE `'t`�ity ��CL'd 1ck,_s State Zip (include suite or floor) Contact Person (Who should we call /write concerning this project ?): CLI S LCI Address (4 C ( �-_wq La ` t'- J `I Gd` City G3 ���,e Sai 1 State Zip C� Daytime Phone Fax tf iC( �0 ", 7 �D E -mail Ok Ct C Nlsqk, CG Business Name /Type: C4 C -0 -A cc 15� �' r11 z'r(C� � LL C, � (.—Lp ,C!`C•k `-1-1 A- \_ C.�G ! Previous Business on this site: Proposed use: 1 C_ SEE CONDITIONS OF APPROVAL IF THE CLEARANCE IS FOR FIREWORK OR CHRISTMAS TREE SALES (Sheet 1) Circle (if applicable): Fireworks / Christmas Tree *This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move the use to a new location, a new Zoning Clearance will be required. I hereby certify that I own or have the owner's permission to use the space indicated on this application. I also certify that the information provided is true and accurate to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will ab' by them. ray &3" ak Al - Si n turelof Busf�Ve�ss wirer or A�—$r.�u. Date 1 ll �L� Sy— Print Name -, APPROVAL INFORMATION [ ] Approved as proposed [ ] Approved with conditions ] 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. ] 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 tt Q60 j �/ r r� Pee Amount $ 35,Cr Date Paid 11� By who? Receipt # ( �, Ck# I /d By: �� GG,'VSFf G t� 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 lnIaKe LU 1:U111111MV 111c 1Ut1vrrlii6. Applicant to complete the following: Do you have one of the following? R YES ❑ NO Tax Map and Parcel Number and or; address of use (include unit or floor if appropriate) R111YES ❑ 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 : oning Tech to e Violations: ❑ YES ❑ NO If so, List: Variance: ❑ YES ❑ NO If so, List: lete the followiniv ❑ YES ❑ NO Is use in LI, HI or PDIP zoning? If so, give applicant a Certified 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 ❑ 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 ❑ NO 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 ❑ 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: 5/1/06 Page 3 of 4