HomeMy WebLinkAboutCLE200600064 Legacy Document 2014-07-08., pf Rico • is � r 1'�
Application for Zoning Clearance���
OFFICE USE O LY�,�h /
❑ Zoning Clearance = $35 CLE # O�i�o _ ((io(ci
PLEASE REVIEW ALL 3 SHEETS Check # Date: 6
Receipt # Staff: QMDF
PARCEL INFORMATION ( ' -;�- 2 . C( p
Tax Map and Parcel: ( Existing Zoning �✓
Parcel Owner: A21 0 S'sD G`1li /( e S G G C
Parcel Address: / 2G'/Y/%��2 /e .� y y/�'�- City 6�X-i 11- -fVt /''-State V Zip
(include suite or floor) ------------------------------------------------
--------------------------- ---------------- - - - - -- -------------------------------------------
PRIMARY CONTACT
Who should we call/write concerning this project? �� 1`f=y oa/ Le . (�Gl�'H !� • �,ZI !/�
Address : lJ o(0 /� ���F'� /Nth' 16C City yvfo'� t' State �' /. Zip Zci
Office Phone: Ia %9�A -9 % 6 L Cell # _
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PROJECT INFORMATION
Business Name/Type: �/�
Previous Business on this site:
Fax #'� A -mail
16,91% ykfa, jpiv y 11 11
Proposed use: of - �Win�m �d4� PC,6[j' Y"S��S � etc //1 f� � y�6'Jb4C'f✓
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 best of my knowledge. I have read the conditions of approval, and /IIuunderstand them, and -tthat I will abide by them.
Signature .s �/t Printed OW,2./a
--------------- --------- ------------------------------------------------------------------------------------------------------------------------
DD1`Ol`�A L INI ORNI AiTION
Approved as proposed [ ] Approved with conditions
r[ ] ackflow 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. BS D an�d/or
[
This site complies with the site plan as of this date.
t1Il'L`+eni Vest I1� to N
Building Official Date 4 �� a G
Zoning Official Date [�� /�Zo&
Other Official Date
------------------------------ - - - - -- - - - -- - - - - - - - -- - -' J -a -( ----------------------------------------------------------
unty 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
Applicant to complete the following:
Y/N
Do you have one of the following?
Tax Map and Parcel Number and or; 6 J-/
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.
Zoning Tech to com
Vi70), s:
Y
the followinLy:
"191A
ariance:
Y/N ii /,
so, List: %� � 1914 I
"` 6 (N U
rDl i �p
Intake to complete the following:
Y /Cj�,.
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y / r
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/(9
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
Y/N
Is on public water and sewer?
Y/0
Will you be putting up a new sign of any kind? If so, obtain
proper Sign permit.
Permit 4
YOU
Will there 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
/Y}' N
so, List:
's N
Tf so List:
Sel %'3b
10/14/05 Page 3 of 4