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Application for Zoning Clearanceyr
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OFFICE USE ONLY 3
Zoning Clearance = $35 CLE # z 0®(? — 7
PLEASE REVIEW A L 3 SHEETS Check # Q-71(7 Date: — Z9—O Ll/
Receipt #, 9/a E3 Staff:
PARCEL INFORMATION y- �d , d(p
Tax Map and Parcel: / •� G Existing Zoning P o m c—
Parcel Owner: T V ` -P2o Pef&-t- i Cs , L L)C,
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Parcel Address: U0 (Include TeF S� N P ,Vwy i S i1Qr �o ifesuill�State V 1 Y(-rl o 0, Zip aoZq
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_ include suite or floor S VT1A nl Lo h
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PRIMARY CONTACT, , ' I
Who should we call/write concerning this project? L Ll V C O
Address: H U 1 &S T" u-°FrelSO N s+ City r (0tf��U1 I (estate O C"- Zip JL' 6-2-
Office Phone: G5 T -R iT)3 Cell# 4V dLga -95!� Fax # 43q 9]V 3(c E -mail DKTitf,ftr,6P -aYAi 46P6L- - eorn
----------------------------------- --- ----------------------------------------------------------------------------------------------------------
PROJECT INFORMATIQN
Business Name /Type: D K S( VA � i
Previous Business on this site: N P_UJ Fa cc II i u
Proposed use: ffi tIb LA L �r-
Circle (if applicable): Fireworks / Christmas Tree
SEE CONDITIONS OF APPROVAL IF THE CLEARANCE IS FOR FIREWQJ 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 a 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 I understand them, and that I will abide by them.
Signature 'S' TLc.� � a� Printed `Sj ,g Ti4 /9 �f9)" 3A 4, rn"
---------------------------------- - - - - -- -------------------------- - - - - -- ----------------------------------- - - - - -- ---------------------------
APPROVAL INFORMATION
Vf Approved as proposed [ • ] Approved with conditions
[ ] Backflow device and/or current test data needed for this site. Contact ACSA 977 4511, x119.
[p 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.
Building Official
I c
Zoning Offlcial
Date
Date
or
977 -4511, x 19.9
.'�/a -b
Other Official Date
----------------------------------- - - - - -- -- - - r - - -�y�- --------------------------- Co"n Nf Albemarle Department 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:
N
Yo you have one of the following?
Tax Map a d Parcel Number and or;
Tress of use me u e umt or oor if appropria e;
( 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. OWA&-� , a-Cl 00 N. Ft .
Zoning Tech to comDlete the following:
Intake to complete the following:
Y lN
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y
Wilt 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
YO
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
yN
on public water and sewer?
Y
Wi you be putting up a new sign of any kind? If so, obtain
proper Sign permit.
Permit #
Y /1'fh
Wil ere 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 #
Viol o s:
Y/
If so, ist:
PrOSI:
Y
If
—3
Var• W4:
Y/
If so, ' t:
SP's
Y/N
Ifs t:
10/14/05 Page 3 of 4
7
Reviewer to complete the following: Z�,6o�
Square footage of Use:
Y / N �Y ��J� 61'l4/� p4 .� 1 vie, r6u Permitted as: (�'- �` �O�'c�l Under Section: AIA A-1 . 1 k d 3.2. b_ 11AA' �
Supplementary regulations section:
Parking formula: n;k60 6
Required spaces:
Y/N
Items to be verified in the field:
Inspector Name & Date:
Notes
Page 4 of 4