HomeMy WebLinkAboutCLE200600005 Legacy Document 2014-06-20Application for Zoning Clearance
❑ Zoning Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
PARCEL INFORMATION
Tax Map and Parcel: T, , M\/) , L 516 - e 1
Parcel Owner: 31" com I''1 im 5 & Mwf A,
a'® to
OFFICE USE ONLY
CLE # —000 5
Check # o i-- Date: Io10 (0-
Receipt # Staff-
Existing Zoning C._ 1 4- V, K ,
O .-7 W-1vt64M ,, cv-
Parcel Address: L) ��I" v r ,) nim -D City a 1A U �S ' State 'V k , Zip
(include sui-e_or floor)
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APPLICANT INFORMATION
Who should we call /write concerning this project? L1 c�'�•LI �lrT y �' 1
Address: 250 vla %ice q Mill II ll Lary— City l / j'17 a State A Zip ,2�oL
Office Phone: ( .,�bD3' 4633 Cell # X-AJ - (, Z) b Fax # E -mail _ I �y1�> �O e,,,, %, irl
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PRIMARY CONTACT
Business Name /Type:
�'
Previous Business
t on this site: °-- o0 z cc �6 (di
Proposed use: l�wvI l XS slux
Circle (if applicable): Fireworks / istmas 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 'havve_reaad the conditions of approval, and I understand them, and that I will abide by them.
Signature lh.YN K- �tJW 1 1 Printed - IyYrtS�tU �1/E'1�}byl
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PROVAL INFORMATION Backflow Device and/or
Approved as proposed [ ] Approved with con iti ftrrent Test Data Needed
Contact ACSA 977 -4511 x 119
[ ] No physical site inspection has been done for this clearance. Therefore, it is not a det � tion- caef- eo�l�ian ting
site plan.
[
This site complies with the site plan as of this date. i
Building Official `Date
Zoning Official Date ! `" Q
Other Official Date
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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:
R V/ N
Do you have one of the following?
Tax Map and Parcel Number and or;
Address of use (include unit or floor if appropriate;
lJ / 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; q 9D 5q-Pt
The square footage of each room or area of use;
Use of each room or area f- '
If using less than the entire structure, note the location within the
structure.
Tech to complete the
V101#4 ons:
If/
Ifs , ist:
VV/ N
S/0 s �� -6.
J i
9/28/05 Page 2 of 4
Intake to complete the following:
Y/®
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Will there 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
"J/ N
Is parcel on -pail} septic?
If so, give applicant a Hea rtment form.
Zoning review can not begin until we receive approval from
Health Dept. FADATE n /1�,'I
/ I zo v 6- P�" My
s o public water ?
Yy N
'Gill you be putting up a new sign of any kind? If so, obtain
proper Sign permit. �
Permit # T` -9
i
Y /ON
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
YC
Is this for sales of Fireworks?
If so, obtain a copy of FIR permit.
Permit #
Yj/N
so, List:
SP'
If /%
If so, st:
9/28/05 Page 3 of 4
Reviewer, to complete the followin�
Square footage of Use:
Y/N
Permitted as: �f C
Under Section: �--
Supplementary regulations section:
Parking formula: -;RKO1 X�i✓' JQO 5F
Required spaces:
Y �N
Items to be verified in the field:
Inspector Name & Date:
Notes
3/28/05 Page 4 of 4