HomeMy WebLinkAboutCLE200600048 Legacy Document 2014-06-13tOY
Pplication for Zoning Clearance
`�RGINIh
OFFICE USE ONLY
r-1
Zoning Clearance = $35 CLE # [mss
PLEASE REVIEW ALL 3 SHEETS Check # 0100103 Date: U
Receipt # 5 Sul 4-1 Staff: _
PARCEL INFORMATION
Tax Map and Parcel: _ "'�(p Existing Zoning
Parcel Owner:
Parcel Address:q 70 City State (/ 6L Zipel,
(include suite_or f[ _- r)-
- ------------- - - - - -- - ---------- - - - - -- -------------------------------------------------------------------
APPLICANT INFORMATION
Who should we call /write concerning this project. �-.,_
i' < r
Address: _uc1c; xufaes f- 49rl City (,Vi�,t"e- State V)J Zip
Office Phone: 1�Z'(� Cell # L19j "O � Fax # ('%b), I-s,55,) -E -mail i � �� ���? 1/11% /i IG1 -� �r.,•�L
�J
---------------------------------------------------------------------------- - - - - -- -
PRIMARY CONTACT - - -- -- - - - - -- -- - - -- - -
Business Name/Type: ,) rl a
Previous Business on this site:
Proposed use: i G4 �✓ U�:.�
Circle (if applicable): Fireworks / Christmas Tree
M
SEE CONDITIONS OF APPROVAL IF THE CLEARANCE IS FOR FIREWORK OR CHRISTMAS TREE SALES (Sheet 1)
*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.
Signature Printed L:Ivl�l
-- ------------------------------------------------------------------------------
APPROVAI; INFORMATION ------------- - - - - -�
�pproved as proposed [ ] Approved with conditions
[ ] No physical site inspection has been done for this clearance.
site plan.
[ ] This site complies with the site plan as of this date.
Therefore, it is not a determination of compliance with t4 existing
and /or
19
J -
Building Official Date
Zoning Official Date
Other Official Date
---------------------------- - - - - -- - - - -- ---- - - - - - -- - - - -- = ---------------------------------------------------------------
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Applicant to complete the following:
Y /�
Do yofi have one of the following?
Tax Map and Parcel Number and or;
Address of use (include unit or floor if appropriate;
�Y/ N
Do you have a Floor Plan (sketch or an architectural drawin g) 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
e
Tech to complete the
Vio
Y
If s
V.
Y
If
P]
Y
If
Y/
If sc
�i �. uiv� r a�,c G Vl °}
Intake to complete the following:
Y/N
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/N
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
Y/N
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
Y/N
Is on public water and sewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain
proper Sign permit.
Permit #
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Y/N
Is this for sales of Fireworks?
If so, obtain a copy of F/R permit.
Permit #
Reviewer to complete the following:
Square footage of Use:
A >
C /yN
Permitted as: fi217,A-4 -e4l ,Oj/L - �(ijJY [ UlY,r,��Y (ILA;
Under Section: .� a� y,J /y� 1rl' 1VtL'4 `'--1
Supplementary regulations section: 5. 1, A-?-
Parking formula: GyWT I0- /�tii -�
Required spaces:
Y/(6)
Items to be verified in the field:
Inspector Name & Date:
Notes
3/28/05 Page 4 of 4