HomeMy WebLinkAboutCLE200600066 Legacy Document 2014-07-08Application for Zoning Clearance
�f ZZoning Clearance _ $35
PLEASE REVIEW ALL 3 SHEETS
PARCEL INFORMATION
Tax Map and Parcel: W // I U—
Parcel Owner: /q a��l1 60,mlj—�
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OFFICE USE O .
CLE # 0rp
Check # _Z50 Date: fl
Receipt # J` 9 / 7 Staff: l MOJ
Cz (�
Existing Zoning Pw
Parcel Address:wq 104 ' City State 00, Zip %�
- - - ----------------- (include suite -or floor)--------------------------------------------------
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APPLICANT INFORMATION
Who should we call /write concerning this project?
Address : ye City, �� State Zip �D,--2,
Office Phone: 17 h Fax # S-% E -mail
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PRIMARY CONT - - - -- - -- -- - - -- - - - --
Business Name/Type:
Previous Business on 1
Proposed use:
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 o nor 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 e b t of my kno led e. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature e Printed__ Ast4L, - y (,/. S C_ (—(ALA
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P OVAL INFORMATION
[ Approved as proposed [ ] Approved with conditions
[ No physical site inspection has been done for this clearance. Therefore, it is not a dete ' ation of compliance with the existing
site plan. ",--- r—•- -- ,.,,,,,,,,
[ ] This site complies with the site plan as of this date Backflow Device and /or
Backflow Device and /or cg 'rent Vest Data Needed
urrent pvt ..._. : < «v -. 4,-
Building Official Date v G
Zoning Official Date // 0
Other Official Date
----------------------------------- - - - - -- t - -- - - =�-� d �- --------------------------------------------------------
Cou Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
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;
Q/N
YO you have a Floor Plan (sketch or af 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:
Viol ns:
Y/
Ifs st:
Var' e:
Y /
If s , st:
51/26N- Vage L of 4
Intake to complete the following:
Y / lI�
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y /( )
Will t ere 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 /1
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
!/ N
on public water and sewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain
proper Sign permit.
Permit #
WY ill / Vtere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Y /(N)
Is this for sales of Fireworks?
If so, obtain a copy of F/R permit.
Permit #
Yroi
Y/
If so, ED
SP's
Y/N
If so, ist:
Reviewer to complete the following: eA
Square footage of Use: V*�,,
Y / N r�
Permuted as:
Under Section:
Supplementary regulations section:
Parking formula:I�
Required spaces:
Y/O
Items to be verified in the field:
Inspector Name & Date:
Notes
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