HomeMy WebLinkAboutCLE200700305 Legacy Document 2014-05-16Application for
Zoning Clearance
Zoning Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
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Tax map and parcel: 12 09 0000 D 7Z V P Existing Zoning: P12 M L
Parcel Owner: ���T'�Y[ t-464�z 'P' L-9AI-14
Parcel Address: ILPSS ITArM FAFM IbLYD City \{'1i-tf�j-�%M�Y W-� State `l A- Zip
(include suite or floor) .P,�- u TEA
Contact Person (Who should we ca-ll /wrrriitee,concerning this project ?): � A �, �'✓,�- t /
Address t C�7�0 �, �t- �lil�7�� x'11 city 1 n ��OPW `7VL�tate N/4— Zip
Daytime Phone 2 E -mail 4fNCKf-M LktE1e Nk41 I.. com
Business Name /Type: C, TIFIEP 6w6 AK-W►&Tm1
Previous Business on this site: LA- Rl y t,.
Proposed use: A-CIgn-rj N cz FI F=1
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
a`bjide by them. 1
Signatur�f BusineMss Owt' � or Agent Date
'.
Print Name
APPROVAL INFORMATION
'/] Ap roved as proposed [ ] Approved with conditions Backilow Device and/or
[ Backflow device and /or current test data needed for this site. Contact ACSA 977 -4511, x] 19. Current Test Data Needed
[ ] No physical site inspection has been done for this clearance. Therefore, it is not a determination of complian
ilto-A �i�t it�e77 -4522, x 129
[ ] This site complies with the site plan as of this date.
Building Official - Date 4 �1
Zoning Official Date jA, 6
Other Official Date
FOR OFFICE USE ONLY CLE # Q06200-?� ( %h / {� C
Pee Amount $3� Date Paid y who? ` j �y, Re-4t S- Receipt # �D ,40 V Ck# 32 U By: l�J
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
dtl Applicant to complete the following:
Do you 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.
: oning Tech to c
Violations:
❑ YES ❑ NO
If so, List:
Variance:
❑ YES ❑ NO
If so, List:
the following:
1ntHKC LO L:0111PIUM LIM 1v1ivrr1i1 V,.
❑ 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 of4