HomeMy WebLinkAboutCLE200600061 Legacy Document 2014-07-08. pP AfyE.,f
Application for Zoning Clearanceria
OFFICE USE ONLY
9-;Koning Clearance = $35 CLE #
PLEASE REVIEW ALL 3 SHEETS Check # ' C7 Date:
Receipt # L Staff: %YI:dN
PARCEL INFORMATION //�� (� ' 3 .a (�
Tax Ma and Parcel: 5 (.e — 0 2 to -� 00 / Existin Zoning tom✓
Parcel Owner:
Parcel Address: 1 g'7 1 S4_- fn ( NO I `e- City (1—h V j )) 2 State �/'�' Zip Z290
_(include suite or floor)- ___-- - - -___ ____
PRIMARY CONTACT
Who should we call /write concerning this project? 'V //`�
Address :I53 D002- D-i VZ CityRl�C1iE1(S✓i 1,e State V0- Zip
Office Phone: U 925- 4-715- Ck# 4 - 0- /l T-ax # E -mail LCMOSE�we—A -'W (1i1 ��• .
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PROJECT INFORMATION /' G
Business Name/Type: CL LLD 6-y Ni; on
Previous Business on this site:�1F S C-► r� 11
Proposed use: � our m.&+ 1-5y-A aL i s �pu ✓4 Ly
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 the best of my knowledgA. I have read the conditions of approval, and I understand, them, and that I will abide by them.
S ignatu V V Printed 1j/� (� Y V. V M �c S
- - - - -- - - -- ---- - - - - -- --------------------------------------------------------- - - ----` ---------------------------------------
APP OVA INFORMATION
[ ] Approved as proposed [ 1 ] Approved with conditions
[ ] Bac ow device and /or current test data needed for this site. Contact ACSA 977 -4511, x119.
,M o 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.
, p oyTVOoR. Sir.4TiNC� . G?o,F;Lu;g 14 06xd Backflow Device an-dl/or�
Building Official Date 'i to
Zoning Official Date Y/// /d 6
Other Official
5.66 Ld P� F' �.� Date � �G�r/<6(.
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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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Applicant to complete the following:
( N
o you have one of the following?
Tax Map and Parcel Number and or;
Address of use (include unit or floor if appropriate;
`D /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 following:
Y //N )
If so t: ACL
Vari
Y/
If so,
Intake to complete the following:
Y/N
Is e ' LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet..
s�Y N G �lvc
Will there be food preparation?
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from
IiealthDept �FAX'DAPE
Y l� yro�
Is parcel on private well and septic?
If so, give applicant a Health Department form.
Zoning review can not begin until we receivq approval from
Health Dept. FAX DATE
N
on public water and sewer?
Y/N
ill you be putting up a new sign of any kind? If so, obtain
proper Sign permit.
Permit #
Y /N`j
Wi th- -e��re be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Is /aIs t or sales of Fireworks?
If so, obtain a copy of F/R permit.
Permit #
Prof
Y/
Ifs Li .
Y/
If sc
10114105 Page 3 of 4
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