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HomeMy WebLinkAboutCLE200600029 Legacy Document 2014-06-1614 rl? Application for Zoning Clearance /�(�:..a;� 1 ' y� v V`—, 6 OFFICE USE ONLY d oning Clearance = $35 CLE # 7 ©'0 (p / PLEASE REVIEW ALL 3 SHEETS Check #- In 1 -7 Date: Receipt # ;S Staff- ' PARCEL INFORMATION / I yo u rv9 be t'_ O_ZZaA a_ :i � Tax Map and Parcel: n(P - 01 (p �d Existing Zoning Parcel Owner: T) �i . T �i (1j ( C, , Parcel Address: 2_% Z Q 13P—r A1'naA City State . Zip (include suite or floor) -- - - - - -- ---------------------------- - -------------------- ------------------ --------------- - - - - -- --------------------------------- PRIMARY CONTACT Who should we call/write concerning �this project] ?? Address: '— , City i State i Zip Z �d J Office Phone: 75 �_61/70Cell # Fax # E -mail ----------------- - -- PROJECT I - ATION `, Business Name/Type: 7 o u (vq I -e e M t2 rcx . f I d �v s G._. i_ Previous Business on this site: Proposed use: Circle (if applicable): Fireworks / Christmas Tree. SEE CONDITIONS OF APPROVAL IF THE CLEARANCE IS FOR FIREWORK OR CHRISTMAS TREE SALES (Sheet I) *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 � best of nvy knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them. Signature !/� Printed ------- - - - - -- - - - --------------------------------------------------------------------------- ----------------------------------------- P ROYAL INFORMATION 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 co,omm 2liance with the existin site plan. Backflow Device and /or [ ] This site complies with the site plan as of this date. Current Test Data Needed Building Official c Date Zoning Official Date Other Official A Date —� —� --------------------- --------------- - - - - - -- - - - - -- -- --- - - - - -- - -� -- -------------------------------------------------------- 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: 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 complete the Violgions: Y / If so, st: v Dance: 2/0, N List: Intake to complete the following: Is Is u n LI, HI or PDIP zoning? If so, give applicant a Certified .Engineer's Report (CER) packet. Wilj—Teere be food preparation? If so, give applicant a Health. Department form. Zoning review cannot begin, until we receive.approval from Health Dept. FAX DATE Y 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 public water and sewer? Y /%I� Wi 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 ("N7) - Is thisTor sales of Fireworks? If so, obtain a copy of F/R permit. Permit # Proff`� s• If so,�bi�t: SP's: Y /] If so, ist: 10114105 Page 3 of 4