HomeMy WebLinkAboutCLE200600026 Legacy Document 2014-06-16Application for Zoning Clearance
Zoning Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
PARCEL INFORMATION
Tax Map and Parcel: 64600•- ao- oo -109co
Parcel Owner:
SOY A(,
(wocaa(
OFFICE USE ONLY
CLE # _ "Z (DC) (o -- a (O
Check # J0--_3 0 Date: 1--31 'D
Receipt # _ �5 $0J q Gj Staff:
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' Existing Zoning Q ry)
JO
Parcel Address: _20 / 5 %5 �c —od
�h' State Zip
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_C nclude suite or g r)--------------------------------------------------------- - - - - --
APPLICANT INFORMATION -- -- - - - -- -- -
Who should we call /write concerning this project? 'aC�c)6(2
ii
Address: State U R
Office Phone: qab SO' Cell # Fax #- 971- 4o25 E -mail �►'Iel.tXirlL�a (j( cO y,
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PRIMARY CONTACT -----------------------
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' Business Name/Type:
Previous Business on this site: S!_U1
Proposed use: hAe 0.,, uv -nr) Cn Swk c 1 .1 U
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 Cent Printed nG�1cA
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PROVAL INFORMATION "- " "- "- - --- -- -
[ j 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. Backtlow Device and/or
Current Test Data N
on ac SA 977 -45 1
Building Official Date �G
Zoning Official Date 012--fYJZ005
Other Official Date
-------------------------- - - - - -- - - A-L ---- - -�. -1
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:
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
Viol o s:
Y/
Ifs . t:
Mete the followin
ariance:
Y/N
If so, List:
Li
V ' If11 -&
V
Intake to complete the following:
Y
Is m LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y IIN
Will re 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 pa el 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 /
Wil ou be putting up a new sign of any kind? If so, obtain
proper Sign permit. � V"
Permit # 5'1 �> V�l� UL r U %U
g
Y/
lather
Wil re be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Y/
Is t ' or sales of Fireworks?
If so, obtain a copy of F/R permit.
Permit #
Y// N
�so,L� ,n�IIq�- oZ�
SP's
Y /(N)
If so, ist:
Reviewer to complete the following:
Square footage of Use: �� 2
Y,/ N
Permitted as: VD SI IJyI J *CU
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces:
Y /N�
Items to be verified in the field:
Inspector Name & Date:
Notes
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