HomeMy WebLinkAboutCLE200600033 Legacy Document 2014-06-16Application for Zoning Clearance
�ni'GIN�P
OFFICE USE ONLY
27-10ning Clearance = $35 CLE # 7- Lo " 3 3
PLEASE REVIEW ALL 3 SHEETS Check # Lp q Date: Z - V - b 0
Receipt # ,5'g� Staff:
PARCEL INFORMATION paect /a,,
Tax Map and Parcel: (0 % ? CC) Qo - 00 ()();g 6 o Existing Zoning ao rn mp/ecLa-?
Parcel
Nef_cAVNo. r-)
v tu.,-
aadAaoa /15 F�Aa&ud5 xiv
Parcel Address: -115-(() 1A City G �c r�6 511 � tate \�) K Zip 1�3a )I
__ (include suite or floor) 21 E-100 4-------------- - - - - --
APPLICANT INFORMATION h f
Who should we call/write concerning this project? ('G --C, -A 1 C a t /�
Address : P a (-b<))( 33 o City Kew CC-f-) State U A Zip -
Office Phone: 2`? -019 7 Cell # 9 q- 53I-A9(aFax # A31-o5_ -3531 E-mail j G 1��� f -� T� N�� �Q�j 0e,
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PRIMARY CONTAC - - -- - - -- -- - - - -- -- - -- -- -
Business Name/Type: L9&4& cn—c -x - \e � �(1 -t-
Previous Business on this site:
Proposed use: C��r-si-cGe
Circle (if applicable): Fireworks / Christmas Tree
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 est of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed_ ('GCy C i k ci�'�'
- - - -- ----------------------------------------------------------------------------------------------------------------
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APROVAL INFORMATION
A pproved as proposed [ ] Approved with conditions
[ ] No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
site plan.
[ ] This site complies with the site plan as of this date. Backflow Device and /or
Current Test Data Needed
I C ontact AC;SA 9 / /-4J 11, x fly
Building Official c Date a o E
Zoning Official Date OZ ZOaC
Other Official Date
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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
Applicant,to complete the following:
Do you have one of the following?
Tax Map and Parcel Number and or;
Address of use (include unit or floor if appropriate;
/ 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.
C
Tech to complete the
If/
If
Vari e:
Y/
If so, ist:
Intake to complete the following:
Is fie'"
m
Is u LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
Y /NS
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 /,0
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
on public water and sewer?
Y
Wil ou be putting up a new sign of any kind? If so, obtain
proper Sign permit.
Permit #
Y /
Will ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Y /0
Is this for sales of Fireworks?
If so, obtain a copy of F/R permit.
Permit #
Yr0Tf
If/
Ifs , :
Yj / N
f so, List:
SP--
neviewer to eom fete ine imiowin : � /
Square footage of Use: 1..� �
Y/N
Permitted as: CtdF'1Ii n���U�e?�i8✓�� eS
Under Section:
Supplementary regulations section:
Parking formula: t�cr�na /�
Required spaces: oC
Y /
Item to be verified in the field:
Inspector Name & Date:
Notes
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