HomeMy WebLinkAboutCLE200600030 Legacy Document 2014-06-16Application for Zoning Clearance: k lA
OFFICE USE ONLY
❑ Zoning Clearance = $35 CLE # l�
PLEASE REVIEW ALL 3 SHEETS Check #R Date:
Receip Staff:
PARCEL INFORMATION
Tax Map and Parcel: _ 4 ��� " 00 -' 00 ° iJG 301✓x`isting Zoning C�} 1'Yl%Yl " f 2-ka;J
Parcel Owner: VQ N CCL �i
Parcel Address: / 9a 5 Bern► NoJe / e L.. City � ,l--�� �� State
_ __ _____ _____ __________(include suite or floor)
- - - - - - -- ------------------------------------------------
PRIMARY CONTACT /� % /
Who should we call/write concerning this project? ���i n i� f/ z 6) e
Address: /fc�L� �LP`»i/�U`e. �rG�G City Mlle- State
1- . Zip ,?,- 2,9 Cl
--------------------------------------------
V!4
Zip zZ90/
Office Phone: Cell # Fax # E -mail A e,- Zl,,?
--------- - - - - -- - - - -- - - - -- -- - - -
PROJECT INFORMATION %J� /
Business Name/Type: /��' �' d 7- 7 � � -// 1) /,"7 u //i s Pr V/G
Previous Business on this site:
Proposed use: z-- �'e-x 2�/rr� ,b�'�/C?
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 �ncled' owned 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 . I have read the conditions of approval, and I understand the /m, and that I will bide by them.
Printed
Signature ���h �fii ��
N -------------------------------------------------- ---------------------------------------------------
XPR
OVA I, ORMATIO
]
Approved as proposed [ ] Approved with conditions
[ Backflow device and /or current test data needed for this site. Contact ACSA 977 -4511, x119.
[ ] No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
site plan.
r i rti:n —i-- .... ..r+i. :n A... +..
Building Official
Zoning Official C aA-K
�. TV
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 10/14/05 Page 2 of 4
3
Applicant to complete the following:
Y/N
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.
Zoning Tech to_.com »'
iolations:',
/N �� 1
S0, List: �
r
ariance:
Y N
110, List:
v�-- t 1 � b --rya l
i
� I
L& OA)
Intake to complete the following:
Y
Is use n I, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y /
Wil 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
Is parml "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?
.Yi/ N
Will you be putting up a new sign of any kind? If so, obtain
proper Sign permit.
Permit # Q a�'.Q�p`�t��
Y / V
Wil ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Is/
Is thi or sales of Fireworks?
If so, obtain a copy of F/R permit.
Permit #
ProSs,:
Y/ If s st:
SP's
Y/N
If s 'st:
10/14/05 Page 3 of 4