HomeMy WebLinkAboutCLE200700294 Legacy Document 2014-05-06i
Application for
Zoning Clearance
❑ Zoning Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
I•�R(;IN��
Tax map and parcel: _ — �� I 6 6 -- e5 j 160 Existing Zoning:
Y
Parcel Owner: (1 n o� C�
Parcel Address:vc City \k � State U . Zip �f /r j
Joclude suite or fldd0J
1 f
Contact Person (Who should we call /write concerning this project ?): I r I '2 � ✓U S
Address P Q J3 ®7C ( -?— City State �4— Zip
Daytime Phone w / 7 V Fax # (___) E -mail
Business Name /Type: e s `s I VD (4 /JJa 7/'-6'
/ ✓1-) (76-Z h t ` \
Previous Business on this site:
oposed
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.
SignatUr�e of B siness wner r Agenj� Date
S b 1 _i r . LF,( / 74J4S K) /0 S
Print Name
APPROVAL INFORMATION
[ ] Approved as proposed
with conditions
] Backflow device and /or current test data needed for this site. Contact ACSA 977 -4511, x119.
] No physical site inspection has been dTie for this clearance. Therefore, it is not a determination of compliance with the existing site plan.
] This site cgipplieh with the sit
g btan as of this dqt_q. j
Building Offici l Date i %-
Zoning Official Date y �'
Other Official Date
V
FOR OFFICE USE ONLY CLE # c2 00 C b6> q e� /J
Pee Amount $ 35 Date Paid By who? SGti> (•(tide p 'Receipt # /3 Ck# 7! �� By: �T "�f
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
A I
Applicant to complete the following:
Do you have one of the following?
❑ YES eNO
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
structiure.
Zoning Tech to
Violations:
❑ YES ❑GIs]
If so, List: 1-1
Variance:
❑ YES
If so, List:
flete the following:
JL11jaHC 6U 1:U111131CM gut 1U11Urr...
❑ YES ❑ NO
Is use in LI HI or PDIP zoning? If so, give applicant a Certified
Engineer's �I eport (CER) packet.
UYESI ❑ NO
ll 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
❑ YESI ❑ NO
Is parcel on private well and septic?
If so, giv0applicant a Health Department form.
Zoning re�,'ew can not begin until we receive approval from
Health Dept. FAX DATE
1
❑ YES I NO
Is on public 'water and sewer?
❑ YES U NO
Will you be pirtting up a new sign of any kind? If so, obtain
proper Sign permit.
Permit #
❑ YES F-1 NO
Will there be any new construction or renovations?
If so, obtain th gproper Permit.
Permit #
❑ YES ❑ NO
Is this for sales of Fireworks?
If so, obtain a copy of F/R permit.
Permit # I
Proffers:
❑ YES D,NO
If so, List:
01 J.
❑ YES
If so, List:
5/ 1 /06 Page 3 of 4
Reviewer to complete the foldim Square fo - age of Use:
R YES ❑
0
Permitted as: w6 "` Q�� �®
Under Section: _ w 6" -" ,
9
Supplementary regulations section:
Parking formula: i�iy�
Required spaces:
❑ YES ❑ NO
Items to be verified in the field:
Inspector Name & Date:
Notes
5/1/06 Page 4 of