HomeMy WebLinkAboutCLE200600051 Legacy Document 2014-07-0814, '.A.pplication for Zoning Clearance II{Cil��`
OFFICE USE O NLY
oning Clearance = $35 CLE # zoo 6 •5-
PLEASE REVIEW ALL 3 SHEETS Check # C 0- -a..f1 Date:
Receipt # 5 S 3 Staff-
PARCEL INFORMATION 5-15-4
Tax Map and Parcel: () -7 q 6 a Existing Zoning_ e �?
Parcel Owner: ,oF ti l= V-L L �
Parcel Address:; � S %�� fe h .n-� -� qty f bU y Chyi 11e State vo,_ Zip z �nl
(include suite or floor) ------------------------------------------- - - - - -- --------------------------
PRIMARY CONTACT M `,
Who should we call /write concerning this project? I 1 I(�Lt- T�OA-
Address: nr`'1' 7-
<5q� 3(m- ' ` .t, + l U &AC State ip
Office Phone: ("Lil "I S J✓ Cell # - U Fax # f f a - U E -mail ' �� j�t + hu tt @1u4 , veG
----- - - - - -- -------------- - - - - -- ---------------------------------------------------------------------------- - - - - -- ----------------------------
PROJECT INFORl�ATION ,�, � __
Business Name/Type: ttprod a d-{ VL I 4 "o' ne- ,
Previous Business on this site: L" 1)1 I x 1_-) r 1 ta .
Proposed use: 00S (�7'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 b�e_sty off my knowledge. I have
read �the conditions of approval, and I understand them, and that I will abide by them.
Signature l�Wl.t.ILi�t.,� ,� �'�=r` U Printed Mar b6L 1-� 17kLi"��e�
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APPROVAL INFORMATION
[V Approved as proposed [ ] Approved with conditions
[ y�ckflow device and /or current test data needed for this site. Contact ACSA 977 -4511, x119.
[ 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. �--
1 Backflow Device and/or
Building Official Date `t (S-
Zoning Official Date (�(i
it
Other Official Date
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County of Albemarle Department of Community Development
401 MCI ti Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 10114105 Page 2 of 4
a
E 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;
Yn/ 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; �t
Use of each room or area
If using less than the entire structure, note the location within the
structure.
NA is
3 n, 4,U10
(Z.5L5t) _j zjE�- �4iiAct.fZ�? J44 -ai
Zoning Tech to complete the following:
Y/
If sc
Osriance:
N
o,��
Intake to complete the following:
Y �.
Is use in LI, HI or PDIP zoning ?, If'so, give.,applicant a.Certified
Engineer's Report. (GER) packet.
Y F.
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'
Y /
Is pa eon 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
Is on public water and sewer?
Y�W e putting up a new sign of any kind? If so, obtain
proper Sign permit.
Permit #
Y CN 'D
Wi ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Y
Is t6-- f0r•sales of Fireworks?
If so; obtain a copy of F/R perriiit;
Permit #
Pro
Y/
If sc
SP's
Y /(
If so,
10114105 Page 3 of 4