HomeMy WebLinkAboutCLE200600028 Legacy Document 2014-06-16A r lication for Zoning Clearance®
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OFFICE US,E ONLY
❑ Zoning Clearance = $35 CLE # �D
PLEASE REVIEW ALL 3 SHEETS Check # Date: o
Receipt # Staff: i
PARCEL INFORMATION (/1) Z -13 -6 4
Tax Map and Parcel: �)59 - ® Existing Zoning _
Parcel Owner:
m�Parcel Address: � I� y� � �� � City State Zip 9
(include suite-or floor)
APPLICANT INFORMATION
Who should we call /write concerning this project? IQ &Y 1-0W e
Address : to. 30,y a107,9A City ,kQ.-- State V Zip%. ao8
Office Phone: 2 ti- 19321 Cell # Fax # E -mail G E L-. 3 \,®V tV (&(m (A _ C- p V
c4) (9)
- - ---------- - --------- - - - - -- -- - -- - - - - -- -- -- - -- -- -- -- -- -- - -- - -- -- - - -- -- -- - - - - - -- - - -- -- - -- -- -- - -- - -
PRIMARY CONTACT n
Business Name /Type: A. U e R pm lL-1 1, L
Previous Business on this site: Utc-
Proposed use: G[ t m t c- A<< C Rq (� y r &t-c a Lj+S
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 best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature �- . �O'l.t�► Printed Giq Ry 0 L-i4.
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A"ROVAL INFORMATION
] Approved 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
Fcurrent..,
Co
Building Official Date']
S/'zow''
Zoning Official Date dZh� -
Other Official Date
---------------------------------- T- 4n)'O-Q) X�- -------- ------- �1 15 -------
ounty of Albemarle Department o Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
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;
0o / N
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.
, oning Tech to
Viol ns:
Y /
If s st:
N
the
9/28/05 Page 2 of 4
Intake to complete the following:
; nN Y
Is use m LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet. ^ C n D 21t4# _ (G A/
Wi111tifere be food preparation? /� P
If so, give applicant a Health Department form. (�M L' �6 C ��
Zoning review can not begin until we receive approval from
Health Dept. FAX DATE CID
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
Y) / N
on public water and sewer?
Y /0
Will you be putting up a new sign of any kind? If so, obtain
proper Sign permit.
Permit #_
,Y) / N
ill there be any new construction or renovations?
If so, obt ' t e pr per Permit.
Permit # 3�
Y / O
Is this for sales of Fireworks?
If so, obtain a copy of F/R permit.
Permit #
/N
f sow ►T 115q-63A5
7f ,. . N
Y;s
o, List:
Reviewer to eomplpte the following:
Square footage of Use:
G
Y/N
Permitted as: SS',on�J(
Under Section: 2z•
Supplementary regulations section:
Parking formula: 4 l7Pd Cc Fe r Zev Sri` t `"T ✓ � 6 ,9,' "g/ 0
Required spaces: A/
Y /O
Items to be verified in the field:
Inspector Name & Date:
Notes
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