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HomeMy WebLinkAboutCLE200600074 Legacy Document 2014-07-08Applica�i0 for Z®ni earan -F-7, ® ' g �� z y �9Rc•crr,. OFFICE USE ONL ning Clearance = $35 CLE # 00 (0 -.coo �2 PLEASE REVIEW ALL 3 SHEETS Check # (� Date: ' Receipt # 5 staff: PARCEL INFORMATION Tax Map and Parcel: ©J7 ZQ� ©Jd" Q7 ~Q� 3 Existing Zoning PMMCI ParcelOwner: A� Dj,�yl�1 `�- i,o�xc 1'CTLI�t { C1Li" Parcel Address: city. State Zip (include suite or floor)_ ----------- - - - - -- - -- .......... -• - -- - - - - -- ----- - - - - -- - - - PRIMARY CONTACT�l j i�Vfl,- • i Who should we call/write concerning this project? Address :17-1 Vt(eSk ySjy -h city J(,�f,IGS�YI Yi ( LP_ State _ zip 32202 Office Phone: �d � i Cell # R0q- X16.3269 Fax # la 4-tooi snail kegs o6- Y ............... :..... ... .. - - - -•- p` -- ... -- -- -- - - - - .... - - -- ....__.. ....._....._..._._......__... -- --•-------------- - - - - -- PROJECT INFORMATI N Business Name/Type: V\ i j/1 1 r f, jr• Previous Business on this site: ' ( Proposed use: c . i I �.3 ✓`=� j l - �J p Circle (if applicable): Fireworks / Christmas Tree . SEE CONDITIONS OF APPROVAL IF THE CLEARANCE IS FORFIREWORK 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 Imo ge. I have read the conditions of approval, and I understand them, and that I will abide by them. Cull& Signature Printed Jenn.i-�er -- ---- - - ------- -- - -------------=--------------------- ------ •- •------- - - - - -- -------------------------------------------------------- -• -= APPROVAL INFORMA ION � .. �..... Approved as proposed [ ] Approved with conditions [ ] Backflow device and/or current test data needed for this site. Contact ACSA 9174511.; x119. - (�}j] No physical site. inspection has been done for.this clearance. Therefore, it is not:a determination of compliance with the existing site plan: ,...... [ ] This site co;r plies with the site plan as of this date. Building Official �. Q; - �=' -..� � - Date. a 6 Zoning Official Date .. �6 0 Other Official Date .............................. - -- "Of OG- • - - - -- - - - - -- - -.. Coubemarle Department of Communi Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 10/14/05 Page 2 of 4 �?A" pp lkito to complete the following: �N. Do you have one of the following? Tax Map and Parcel Number and or; Address of use (include unit or floor if appropriate; Y/N 'Ero—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. Tech to complete the'following: Intake to complete the following: Is a LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. •r Will�therree be food preparation? . If so, give applicant a Health Department form.. Zoning review can not begin until we receive'aproval from Health Dept. FAX DATE Y / n I parcel o 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 Is 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 # Y Wil ere be any new construction or renovations? :.. If'so; 'obtain the proper Permit: ` . Permit # " Y' Is thi or: sales of Fireworks? " If so, obtain a copy of F/R permit. Permit # ariance: YIN fso;' List:.._.._.. ._..._....__.,......__......_._ ........ . . ............. __._ ._ At X04= 10/14/05 Page 3 of 4 Rev iewerlo.complde the;following 1; ;�, = `..., -• w , >- are footage of Use���r ermitted.as.\ /L =P .►rr��r( V� Under Section: .SuP' P �Y lemen re lattons section "' ;•f '- Parking formula: ` c Re4uired spaces: YEN Items. to be verified in the'field i Inspector Name & Date: Notes. i e tr1 a 10/14/05 Page 4 of 4