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HomeMy WebLinkAboutCLE200600008 Legacy Document 2014-06-20Application for Zoning Clearance C[Receipt E USE ONLY oning Clearance = $35 ZO©CQ -- 0000 PLEASE REVIEW ALL 3 SHEETS # '+Q-7,"I Date: 1— a R — 0 W # S-79! �i Staff: , PARCEL INFORMATION Yi� Tax Map and Parcel: 77� L(-rn J__7 Existing Zonin Parcel Owner: , h, i�� W1 V" 5 4 Parcel Address;., 13 Shy � �� ( j1 City Q-Y'�2 Q-A- State VA— Zip 2�.q 2 (include - suite -or floor) - ------------------- --------------- - - - - -- -------------------------------------------------------------------------------------------- PRIMARY CO-N--T-- A- -CT P Who should we call/write concerning this project? kh'�4 Vl �46,A 14- ' Address: 50-'� �rr City State Zip 7 Office Phone: 1 cl-7 4 b � 1 Cell # 6� 9 Fax # cn �� E( mail I `yt(i"N'7C ✓n�y�� c��S 7't1� CM" ------------------------------------------------------------------------------------------------------------------------------------------------ PROJECT INFORMATION Business Name/Type: h'..Q �r1T'r�� -- 'SVC—, L—t—C Previous Business on this site: Proposed use: r'1-dw,e_ 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 Printed 1; �, (At J,, 44e._ ------------------------------------------------------------------- ---- ---------------- - :determination -------------------------------------------- APPROVAL INFORMATION [ ] Approved as proposed Approved with s [ ] Backflow device and/or current test data needed for thi ' e. Contact ACSA 9 - .4 [ ] No ph sical site inspection has been done for this clearance. There ore, it is not a of compliance with the existing site plan. Z 4 [ ] This site complies with the site plan as of this date. A# 00 r--- ii Building Official Date (S I d to Zonin g Official Date Gr-- Other Official / ,, ate •----------------------- - - - - -- - - - - - -- - - - -- - ----- - - - - -- -� - ��E! -' -- ------ - - - - -- County of Albemarle Depar meat of Community 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: ------------------------------------------- Development (434) 972 -4126 10/14/05 Page 2 of 4 Applicant to complete the following: /N' Do you have one of the following? Tax Map and Parcel Number and or; Address of use (include unit or floor if appropriate; YD /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. q- Zoning Tech to complete the following: Vio ions: P1 l: Y If Y o. L� If Aariance: (Y)/ N moo, List: I/& Intake to complete the following: Y Is m LI, HI or PDIP zoning? Engineer's Report (CER) packet. If so, give applicant a Certified Y /1�1► 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 Yom/ N 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 1- 1 2 - to Y /(E %C�l Is on public water and sewer? Y/K Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Y/ Wil ere be any new construction or renovations? If so, obtain the proper Permit. Permit # Y Is this for sales of Fireworks? If so, obtain a copy of F/R permit. Permit # Y's N f so, List: Ito- 10/14/05 Page 3 of 4 Reviewer to complete the following: Square footage of Use: Y/N Permitted as: Under Section: Supplementary regulations section: _ Parking formula: Required spaces: Y/N Items to be verified in the field: Inspector Name & Date: Notes 10114105 Page 4 of 4