HomeMy WebLinkAboutCLE200600007 Legacy Document 2014-06-20Circle (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 accura ^ o the breast of my know) .dge. I have read the conditions of approval, and I understand them, and that I will abide by them.
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Sig ��
....................................... ----------------------------------------------------------------------------------------------- - - - - -- - - --
A,P,PROVAL INFORMATION
[ Approved as proposed ' [ ] Approved with conditions
[ ] Backflow device and /or current test data needed for this site. Contact ACSA 977
[ ] No physical site inspection has been done for this clearance. Therefore, it is not deta$�61iX�iajttiphiailSit the existing
site plan. Cti rrent Test Data Nestled
[ ] This site complies with the site plan as of this date. Q'Qatact ACSA. 917 -4511; x 119
Building Official Date v C.
Zoning Official Date
Other Official Date
.--------------- - - - - -- - - -- c1 ��Lkj_L -� -.._� = � - � � -� -- -- - - -- -
Coun of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 10114105 Page 2 of 4
Application for Zoning
Clearance
41
OFFICE USE
❑ Zoning Clearance = $35
CLE #
PLEASE REVIEW ALL 3 SHEETS
Check # . 0 Date: ji
Mz,
Receipt # Staff:
PARCEL INFORMATION
iQ _D G
nn
Tax Map and Parcel: F (- 10 0— 0 1— O A v 0 1 o A 0 Existing "Zoning
Parcel Owner: /h • 0 "✓i✓ I t/
Parcel Address: )3=U (o,, a,. L�Pa W- b r°%
City CI^c�j1 o+-%s Litt lestate JL4
Zip' 7� v
(include suite or floor)
----=-------- -- - - -- --------------------
_______________________
PRIMARY CONTACT
Who should we call/write concerning this prorje.09
Address : 7'3 SO eo,, r.1 OA Vver lir I�f .r Sti, �/
City Ch, State U
Zip �acf U 1
Office Phone: (' - I 1 q 7 S 7330 Cell # `i?Lf'7b0
"TS6ax # SV - 97S -367q E -mail
---- - - - - -- -----•----------------------------------------------------------------------------------------------------
" INFORMATION
Pk6k fl_
Business Name/Type.: �ZCi G I%W
/
C�� CM
Previous Business on this site: o^'
Proposed use: D
Circle (if applicable): Fireworks / Christmas Tree
SEE CONDITIONS OF APPROVAL IF THE CLEARANCE IS FOR FIREWORK OR CHRISTMAS TREE SALES (Sheet 1)
*This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move the use to a new location, a new Zoning
Clearance will be required.
I hereby certify that I own or have the owner's permission to use the space indicated on this application. I also certify that the information provided is
true and accura ^ o the breast of my know) .dge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Si nature `tC ! C Printed C C� C F ��y 3 7 � yV�
Sig ��
....................................... ----------------------------------------------------------------------------------------------- - - - - -- - - --
A,P,PROVAL INFORMATION
[ Approved as proposed ' [ ] Approved with conditions
[ ] Backflow device and /or current test data needed for this site. Contact ACSA 977
[ ] No physical site inspection has been done for this clearance. Therefore, it is not deta$�61iX�iajttiphiailSit the existing
site plan. Cti rrent Test Data Nestled
[ ] This site complies with the site plan as of this date. Q'Qatact ACSA. 917 -4511; x 119
Building Official Date v C.
Zoning Official Date
Other Official Date
.--------------- - - - - -- - - -- c1 ��Lkj_L -� -.._� = � - � � -� -- -- - - -- -
Coun of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 10114105 Page 2 of 4
51
Applicant to complete the following:
;z N
ou have one of the following ?.
Tax Map and Parcel Number and or;
Address of use (include unit or floor if appropriate;
N
o 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
Y
If
Vary ce:
Y /
If so, st:
Intake to complete the following:
Y N
Is =I, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/
Wil 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
Ypa�on Is 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
ublic water and sewer?
Y
Wil o e putting up anew sign of any kind? If so, obtain
proper ign permit.
Permit #
Y N
Wi e be any new construction or renovations?
If so, ain the proper Permit.
Permit #
Y N
Is thr sales of Fireworks?
If so, obtain a copy of F/R permit.
Permit #
Prof s:
Y so /
If , 6st:
SP' .
If st:
10/14/05 Page 3 of 4
r
Reviewer to complete the following: ��
Square footage of Use:
Permitted as: �IC
Under Section;
Supplementary regulations section:
Parking formula:
a
Required spaces:
Y / 0
Items to be verified in the field:
Inspector Name & Date:
Notes
10/14/05 Page 4 of 4