HomeMy WebLinkAboutCLE200600043 Legacy Document 2014-06-13Application for Zoning learaVUL
nce
OFFICE IISbBNLY
CLE # �t
❑ Zoning Clearance = $35 Check #
PLEASE REVIEW ALL 4 SHEETS Receipt #15 s
PARCEL INFORMATION
Tax Map and Parcel: 7 Existing,'
Parcel Owner:
Parcel Address
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Date:
Staff: S
Toning
City 4�e. 8 kv State
Zip 2, Z 90L
APPLICANT INFORMATION
Who should we call/write concerning this project? \
Address : /%ij �� City .t c'c._ Statel Zip 2� Z
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Office Phone: ( %Cf��C� Cell # Fax # ! ° % M E -mail
PROJECT INFORM TION
Business Name /Type: t c_5 y
Previous Business on this site:y?�
Proposed use:eX��v� �e -
Circle (if applicable): Fireworks / Christmas Tree
SEE CONDITIONS OF APPROVAL IF THE CLEARANCE IS FOR FIREWORK
I
*This Clearance will only be valid on the parcel for which it is approved. If you change, intensify of
Clearance will be required. j
I hereby certify that I own or have the owner's permission to use the space indicated on this app]
true and accurate to the best of my knowledge. I have read the conditions of approval, and I und,
Signature Pri
--------------------------------------------------------------------------------------- - - - - --
'PROVAL INFORMATION
) Approved as proposed
( ) Approved with
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�.,,� •S �rvea� � �r- �,�tr� saxgrilt ➢r' _ _ � _ __._ _ I
r;;m-nt 'I PO Data Needed
ar-t A CS Q LX119
Building Official r. Date C�
Zoning Official - Date
Other Official Date
------------------ - - - - -- K - -1 -- - �- - -- -- - - - -- er_�ment - - - -- = - - -- - - County of Albemarle Depa of Communiy Develop t
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
3/28/05 Page 2 of 4
Applicant to complete the following:
ON
Do you 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 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.
Tech to complete the
Y
If
Y
If
Y
If
Y
If
Intake to complete the following:
Y /L�,?
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y/
Will ere 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 ' ale 1 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
N
public water and sewer?
,-Y/ N
. Will you be putting up a new sign of any kind? If so, obtain
proper Sign permit.
Permit #
'er
the new construction or renovations?
1L be an y
If so, obtain the proper Permit.
Permit #
Y /tN
Is 1 or�sales of Fireworks?
If so obtain a copy of F/R permit.
Permit #
3/28/05 Page 3 of 4
Reviewer to complete the following:
Square footage of Use: 1 0
I
Y/N
Permitted as: `Gu "' V.,2. calS k25"& T4j T?a�e%'ld�t�
Under Section: ' Z' (7 ,
Supplementary regulations section:
Parking formula: ve4/ 2,065f
Required spaces:
Y /6)))
Items to be verified in the field:
Inspector Name & Date:
Notes
3/28/05 Page 4 of 4