HomeMy WebLinkAboutCLE200600062 Legacy Document 2014-07-08Application for Zoning Clearanee - .
OFFICE USE
❑ Zoning Clearance = $35 CLE #
PLEASE REVIEW ALL 3 SHEETS Check # Date: 1;2U o(v
Receipt # Staff: 1'
PARCEL INFORMATION n -a_&6&
Tax Map and Parcel: lea V yt/ V 6 :W c), Existing Zoning Y-C
Parcel Owner:
Parcel Addressail V
City L�a&' State 0 CA--
(include suite or floor)v - - - - -- -----------------------------------------
--- - ------------------------ --------- --------- ----- ...................
PRIMARY CONTACT j�/� �
Who should we call /write concerning this project? + `«
Address : Fi r /rte_ Crl City �� V I {'� State V l+"T Zip
Office Phone: Lab qe, l 72_ Cell # 9?2_2_S 32 Fax # E -mail ( —es
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PROJECT INFORMATION
Business Name/Type: ,C=& r,� \%
PT
Previous Business on this site:
� S
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 n or a e the owner's permission to use the space indicated on this application. I also certify that the information provided is
true and accurate to i best o�my kno edge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed I GL - �J1U )'1(,
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APPROVAL IN RMAT N
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 o omplian 1111ith the existin
site plan.
[ ] This site complies with the site plan as of this date. Jia '1 ulffv Device and /or
Cur Test Data Needed
On
Building Official Date 3 I a--� —k C,
Zoning Official Date 03
Other Official ate
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unty of Albe- ma- -- rle Department of Community Development
401 McIntire Road Charlottesville; VA 22902 Voice: (434).296 -5832 Fax: (434) 972 -4126 10 /14 /05.Page 2 of4
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;
Y N
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 com
Vio ns:
Y/
If s Li
V
Y
If
Mete the followin
P1
Y
If
SP
Y
If s
Intake to complete the following:
Y /Q
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
Y/N
If so, give applicant a Certified
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 -N
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
0/ N
Is on public water and sewer?
Y / O
Will you be putting up a new sign of any kind? If so, obtain
proper Sign permit.
Permit #
Y /qWill t ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Y /OI
Is this for sales of Fireworks?
If so, obtain a copy of F/R permit.
Permit #
10114105 Page 3 of 4