HomeMy WebLinkAboutCLE200700304 Legacy Document 2014-05-16Application for
Zoning Clearance,
❑ Zoning Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
Tax map and parcel: 4(,,_, e — l —(D2 ip Existing Zoning: LO
Parcel Owner: Ha1(Y y0,,e,1 4 f rO is I O 110. Ce , L,L C
ParcelAddress: 1560 l.Ksu_v -0.rttw_ /—P. City :: k&e'lo. —kIK U;�//
State Zip 2.2q11
(include suite or floor)
Contact Person (Who should we call/write concerning this project ?): � t'?Q�evL , _ �° 140 ti
Address Lcl,, Riyfrbv�Kd Dr. City ��ecr'ry��s�i /(e' State y,4 Zip224/
Daytime Phone d3Y ) T7 82 T ( Fax # 0�) I? !6 - 3S10 E -mail V LCSMELIV/V(y/}O L .GoA+,
BusinessName/Type: ?iej1►1OA nn1K 4._tK1 ( �Qdie ?rte. LLP
Previous Business on this site: i EYtCC (Q,04 1, CA . rmS 11Q��'+�a. l io r�st� `v w , cs la t
Proposed use: R2dt ea 1 ow' e •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 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 b hem.
7
Signature of Business Owner o Age Date
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 i
Zoning Official Date Z
Other Official Date
FOR OFFI NLY y�� �,��p(� #
Fee Amount $ Date Paip By who. - Receipt #(90 7 Ck #� 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
Applicant to complete the following:
Do you have one of the following?
Ell"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.
Zoning Tech to
Violations:��
F-1 YES Li' N
If so, List:
❑ YES dNO
If so, List:
lete the
Intake to complete the following:
❑ YES [2/NO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
❑ YES
Will there b P/O/NO
od preparation?
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from
Health Dept. FAX DATE
❑ YES V 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
7 Healt 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 [(NO
Will there be any new construction or renovations?
If so, obt ' the Pao, e Pe it.
Permit # V a- i1
❑ YES NO
Is this for sat es of Fireworks?
If so, obtain a copy of F/R permit.
Permit #
Proffers:
❑ YES 0 NO
If so,
'I
If
SP's:
❑ YES NO
If so, List:
5/1/06 Page 3 oF4
Reviewer to complete the foil
Square ootage of Use:
YES ❑ NO
Permitted as: Pi—Al LMICI (Nll Al b
I Under Section: 1 V. /IV , 4 t
Supplementary regulations section:
Parking formula:
Required spaces:
❑ YES ❑ NO
Items to be verified in the field:
Inspector Name & Date:
I Notes
5/1/06 Page 4 of4