HomeMy WebLinkAboutCLE200600042 Legacy Document 2014-06-13UB Al, yE�
Application for Zoning Clearance
OFFICE USE ONLY
F-1 Zoning Clearance = $35 CLE # J
PLEASE REVIEW ALL 3 SHEETS Check # % M Date: �
Receipt -77 _ Staff:
PARCEL INFORMATION ('� j
Tax Map and Parcel: (D l 1 "S C` _ \'� t 't L,� °l i On Existing Zoning
Parcel Owner: J-[ fY'tL./ 1 J�' i �1C41n l_ f` V.� Amok) � �,(k
Parcel Address: ,1 .1 ��L'1 n��N C City.. V q( i iliState.
(include suite or floor)
zip
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PRIMARY CONT__ ACT l _.
Who should we call /write concerning this project? `' ;� �/ V 10 i °n 73 - P 1,34
Address: ; ;�L �-� I.� �� �/ l f' L� ('� City r`�� State _
Office Phone: ON)` % �' 1 i Cell # Ll�1�" Ji' , S� # -� - E -mail
Zip`7
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PROJECT INFORMATION ;a'� i ,. i _E ti
Business Name/Type: r ;' (li? ? g c, t1 r f' < C i �� (i�
Previous Business on this
Proposed use:
Circle (if applicable): Fireworks / Christmas Tree
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sks�, - Mra
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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 se the space indicated on this application. I also certify that the information provided is
true and accurate to the best of my kno edge„ I haye read t e conditions of approval, and I understand them, and that will abide by them.
% 1.
Signature r`r 'ill/1 ` rf. r b Printed
APPRO V AL, INFORMATI ON
[ ] Approved as propojsed [ ] Approved with conditions
[ ] Backflow device and /or current test data needed for this site. Contact ACSA 977 -4511TContact x119
[ ] No physical site inspection has been done for this clearance. Therefore, it is not a det �grinpelt c„etit ft}p ex
site plan.
[ ] This site complies with the site plan as of this date. Current Test Data iRit %eel
A . % \ J CSP-,. 977 -4511, x 119
Bui lding
Zoning Official
Other Official
l
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County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 10114105 Page 2 of 4
f
Applicant to complete the following:
Y N
"I Doo you have one of the following?
Tax Map and Parcel Number and or;
Address of use (include unit, or floor if appropriate;
YPN
15o 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 complete the
.
►. !
— - ■r:�-
��
Vari e:
/IN I
Ifs L' t:
Intake to complete the following:
Y/N
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
Y /N
If so, give applicant a Certified
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
0/N
Is on public water and sewer?
ON
Will you be putting up a new sign of any kind? If so, obtain
proper Sign permit.
Permit #
Y /CN)
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Is /(N
Is this or sales of Fireworks?
If so, obtain a copy of F/R permit.
Permit #
Prof r
Y/
Ifs Li .
SP's:
If /
Ifs Li t:
10114105 Page 3 of 4