HomeMy WebLinkAboutCLE200600053 Legacy Document 2014-07-08o.
Application for Zoning Clearance
❑ Zoning Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
PARCEL INFORMATION
OFFICE USE ONLY
CLE # 6— — OCO 1,50
Check # UM(: Date: d (7
Receipt # w Staff• /1
CIQ
Tax Map and Parcel: 06 6M -- no -- 00 —06 -7C-0 Existing Zoning l�
Parcel Owner: "R6 b erz+ + • 7i
pt e1l,�
41 /tGi�)�
�" �J ro
Parcel Address: 9971fJA IY\(�r,� G`-+-!° 2�, �L` city Cut er State Zip Jog3 JJ
(include suite or floor) ---------------------------------------------------------
PRIMARY CONTACT
Who should we call /write concerning this project? JA,-2!'i �1-
Address : City C,V i State V,1- Zip a q 03
Office Phone: � w %� V �L,A C ( p (, Cun1 9 ,
-- -------- - - - - -- ------------------------------------------------------- - - - - -- ------------------------------------ - - - - -- -------- - - - - --
PROJECT INFORMATION
Business Name/Type: w o-P.14 S, L L C
i Q �
Previous Business on' ft,,his site:
Proposed use: `rl�?d>}'-, Cw.Sr� Q• > .�
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.
1 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 ZtJ. � ��rr�r -�"- Printed �1-,Az�c12,_,; W /91Fhkkio- T-
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APPROVAL INFORMATION
eK Approved as proposed [ ] Approved with conditions
[ ] Backflow 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. Rackflow Device and /or
C-Pntacf- ACSA 977-4511,:x 119
Building Official Date �-(j !o a G
c
Zoning Official Date 5 O�
Other Official Date
------------------------- - - - - -- . -- Z4!partment --------------------
County of Albem of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 10114105 Page 2 of 4
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;
OY /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.
Zonirg Tech to complete the
Y /(If so,
Var' e:
Y/
If s , Li t:
P1
Y
If
SP'
Y/
If sc
Intake to complete,the following:
Y
Is use LI, HI or PDIP zoning? If so, give applicant a Certified
Enginee?s.Reporh (C•ER),packet • ,, . d
Y No
Will there be food preparation?
If so, give applicanoa =•Health Department form.
Zoning review can not begin until we receive approval from
Health Dept. FAX DATE., * i,
Y /U
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
U/N
Is on public water and sewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain
proper Sign permit. , (A'
Permit # D W vYiv o� b 144 ��
Y/
Will tere 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 #
10/14105 Page 3 of 4