HomeMy WebLinkAboutCLE200600037 Legacy Document 2014-06-13pF e11, yE,j
Application for Zoning Clearance`
OFFICE USE ONLY n
/Zoning Clearance = $35 CLE # /
PLEASE REVIEW ALL 3 SHEETS Check # SW Date:
Receipt # Staff:
PARCEL INFORMATION ry V.
Tax Map and Parcel: .?r — J' Existing Zoning Le
Parcel Owner:
Parcel Address: City State Zip
- -- (include suite or floor) -
----------- - - - - -- - -
PRIMARY CONTACT
Who should we call /write concerning this project? L -'� +�� �� jnC' S
Address: ��� �C ��¢ JQ,4e <Si« �r�G City N1S�IlrYv<,,YC' State V 1'y Zip Z 2 1
-� 00 Office Phone: Z Cell #
Fax P
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PROJECT INFORMATI (I--
Business Name/Type:L�
Previous Business on this site: G'�C�`r'�
Proposed use: Q cc' -, — `mss(,"- -, j
Circle (if applicable): Fireworks / Christmas Tree
E -mail
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 a owner's permission to use the space indicated on this application. I also certify that the information provided is
true and accurate to the b nowledge. ave read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed ' � rtc, FS ='`� -Cl z� 701 I
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APPROVAL INFORMATION
�N Approved as proposed [ ] Approved with conditions
[ ] Backflow device and /or current test data needed for this site.
[ ] No physical site inspection has been done for this clearance.
site plan.
[ ] This site complies with the site plan as of this date.
Contact ACSA 977 -4511, x119.
Therefore, it is not a determination of compliance with the existing
Building + Sf1..�r Date )j
Zoning Official Date
Other Official Date
Baddlow Device and /or
19
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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 10/14/05 Page 2 of 4
Applicant to complete the following:
0 I' / N
o you have one of the following?
Tax Map and Parcel Number and or;
Address of use (include unit or floor if appropriate;
Q/ N
o 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.
/.�� S
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Q t-pv t
Zoning Tech to complete the
Vi ons:
Y N
If s , L' t:
Va
Y/
If so
Intake to complete the following:
Y
Is n LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet'
Y
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
/N
is on public water and sewer?
Y�
Will you be putting up a new sign of any kind? If so, obtain
proper Sign permit.
Permit #
N
1 there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
C-
YO
39 7 A L-
Is this for sales of Fireworks?
If so, obtain a copy of F/R permit.
Permit #
Pro
Y/
If sc
SP
Y
If
10114105 Page 3 of 4