HomeMy WebLinkAboutCLE200600056 Legacy Document 2014-07-08Application for Zoning ClearanceF]-
OFFICE USE ONLY
Zoning Clearance = $35 CLE #
PLEASE REVIEW ALL 3 SHEETS Check # 343 9 y Date: 3— -7-0(a
Receipt # 5 8 8 4 3 Staff:
PARCEL INFORMATION W : 3- 1 ? -6(o
Tax Map and Parcel: L 17 �
Parcel Owner: G' 'Qec1 PP
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e Jni 4,4/ `r +i
Existing Zoning POP
f L n I l SL/�b A 4/
Parcel Address: J"l0��' �� K�O City C/1•(-} V,)JFState
______ __ _ __ __ _______ _(includesuit_Iorfloo►`)
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PRIMARY CONTACT (�
Who should we call /write concerning this project? J��e-f7�P Pa cue 1l - P1 r 1 J/
Address: 10-5- S�oly e L �` c1 �' 1�J , ty )t?f' 'S V; //1PState V'4 Zip,9 D
Office Phone: &3% v��l 'M�CellAT 8P) ax #� V DW -63 6 -mail ►m IIS rrl /� Ub 40!44
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PROJECT INFORMATION J
Business Name /Type: /bl N i% (] b ''V �v
Previous Business on this site:
Proposed user OIL 6 A n 1, s e, 6 N i?0 Pee `__ 6:p0 vN J• ,
S .3 a q ad- 2 5
Circle (if applicabl Fir s / vCtlna ree
SEE CONDITIONS O PPRO L IF TH CLEARANCE IS FOR FIREWORK OR CHRISTMAS TREE SALES (Sheet 1)
*This Clearance will only be
Clearance will be required.
which it is approved. If you change, intensify or move the use to a new location, a new Zoning
I hereby certify that I own or have the owner's pennission to use the space indicated on this application. I also certify that the information provided is
true and accurate to the best of my faro ledge. I have read the conditions of approval, and I understand them, and that I will) abide by them.
Signature GrY uvZ�'U �� � Printed Je AN -e��e �� 7 �1 C21 &
I
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APPROVAL INFORMATION
[ ] Approved as proposed [ ] Approved with conditions
[ ] Bacicflow 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 determir atiot c rar e ilrthmexi *in
site plan.
'�A2 W }�evice and /or
[ ] This site complies with the site plan as of this date. Current pest Data Needed
ontact ACSA 977
Building Official Date
` r '
Zoning Officiall �a e •
Other Official Af 3SL. I,$ t e
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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 10/14/05 Page 2 of 4
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C)YIpplica to complete the following:
N you have one of the following?
Tax Map and Parcel Number and or;
Address of use (include unit or floor if appropriate;
Y/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.
f"
Zoning Tech to com
Vio ns:
Y N
Ifs , Li
the followin
Vari e:
Y/
If so, Lis .
b k'
Y
If
Intake to complete the following:
Y/N�
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Wi6re 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 /N'
Is pa •ce 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
V onpublic water and sewer?
Y /N6
Will you be putting up a new sign of any kind? If so, obtain
proper Sign permit.
Permit #
Y //N
Wild ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Y /,I)
Is t for sales of Fireworks?
If so, obtain a copy of F/R permit.
Permit #
SP's
Y /
If so L' t:
10/14/05 Page 3 of 4