HomeMy WebLinkAboutCLE200600017 Legacy Document 2014-06-20OV
Application for Zoning Clearance CQJ a� m
OFFICE USE ONLY
❑ Zoning Clearance = $35 CLE #�
PLEASE REVIEW ALL 3 SHEETS Check # Date: % 1i /Ul
Receipt # D Staff:
PARCEL INFORMATION
Tax Map and Parpl: 0101 WO Existing Zoning
Parcel Owner:
Parcel Add
State
_ - AP_P LI ----------------- (ncde uor floor__
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CANT INFORMATION
Who should we call /write concerning this project? QaltsI /�S-A1 I 5
Zip 6 /
Address : '1 C� f er,yxcr3 e T[� LR,46►e-- City State V Zip Zz f� r
Office Phone: ('34 ,Y5yy Cell # S34-177-2 Fax # 2,ac3, x{553 E -mail t 5nv..✓�s�rl�a�1 � ^r/� ,,�k.
- ---------------------------------------------------------- -----------------------------------------------------------------------------------
PRIMARY CONTACT _
Business Name /Type:
Previous Business on this site: inJ�2
Proposed use: `772> jB;a1tru4 t 1 Q,�ea [y,� f✓ �p1�rrcr'€-Tcr�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 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, andd�I understand them, and that I will abide by them.
Signature Printed 45 ',SA.�-.&
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APPROVAL INFORMATION
X71 Approved as proposed [ ] Approved with conditions
[ ] No physical site inspection has been done for this clearance.
site plan.
[ ] This site complies with the site plan as of this date.
Therefore, it is not a determination of compliance with the existing
Backtiow Device
Building Official Date
Zoning Official Date
Other Official Date
--------------------------------- - - - - �- - - -2 _ �� r6� ---------------------
- -- -- -- -- -- - -
ounty of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
A pplicant to complete the following:
r_ SIN
Do you have one of the following?
Tax Map and Parcel Number and or;
Address of use (include unit or floor if appropriate;
YIN
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. 3
E!41
Tech to complete the
Viol ns:
Y/N
Ifs -st:
Y
If
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Intake to complete the following:
Y / �N?
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
WiH-tlfere be food re aration?
P P
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from
Health Dept. FAX DATE
Y / NO
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?
YIN
Will you be putting up a new sign of any kind? If so, obtain
proper Sign permit.
Permit #
YIN
Will there be any new construction or renovations?
If so, obtain the pro er Permit.
Permit #
YIN
Is this for sales of Fireworks?
If so, obtain a copy of FIR permit.
Permit #
Vari nC : SP's
Y IN Y/
If so, If so,
R Hewer to complete the following:
Square footage of Use:
yV N ,
Permitted as: Ss ( 01,
Under Section: .2 -2 - :1 (6) '1
Supplementary regulations section:
Parking formula: S- QA(b - O5O — N& l
Required spaces: `t• S��tG�S
Y lD
Items to be verified in the field:
Inspector Name & Date:
Notes
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