HomeMy WebLinkAboutCLE200600078 Legacy Document 2014-07-16o
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Application for Zoning Clearance
OFFICE USE ONLY
/Zoning Clearance = $35 CLE # -zco to -7 9
PLEASE REVIEW ALL 3 SHEETS Check # 14q"5197 Date: -30
Receipt # �5g2'$ ?3 Staff: bc
PARCEL INFORMATION 6gE66.0 -06-6f(�& 5-36 —O(o t
P �Se.✓
Tax Map and Parcel: M0 5k_ on I w ll Existing Zoning —�
Parcel Owner:_ ��1� N • SJ C-06l
Parcel Address: NO NJ( &9P_r- City 0 , r )kV1Y1e State Zip 2-z e
........... (include suite or floor)
PRIMARY CONTACT �J_ , r1 ew
Who should we call /write concerning this project? i ((�I (J�
Address : �7 " �'7 7 �« � � - -1� C c� City /�� Iso� State Zip Zz
Office Phone: cl:M) 4
Ak ' 86 q4 Cell #5'qd ` 7i:�L%�} %Fax # E -mail Cab= �Vl�rt� j/� jyfUSl, 1-ky
PROJECT INFORMATION n „
Business Name /Type:
Previous Business on this site: CO C► PAr `'�'M C e 5'1' re .
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 iy knowledge. I have r ad t conditions of approval, and I understand them, and that I will a bide by them.
Signature Printed �SU&6( %
- -- -----------------------•-------•---------------------- ....- •------- •----- •---- • -• -... ...............
APPROVAL IN ORMATION
[ Approved as proposed
[ ] Backflow device and/or current test data needed for this site.
No physical site inspection has been done for this clearance.
site plan.
[ ] This site complies with the site plan as of this date.
] Approved with conditions
Contact ACSA 977 -4511, x119.
Therefore, it is not a determination of compliance with the existing
Backflow Device and/or
Building Official... '` _�— Date
Zoning Official Date 4,41
Other Official ate
------------------- ---------- - - - - -- - - - - - - - - -- - -- ----------------------------------------------
C�ounty 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:
0/N
o you have one of the following?
Tax Map and Parcel Number and or;
Address of use (include unit or floor if appropriate;
®/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.
Zonint= Tech to complete the
Viol ns
Y/P
If s , Li
ariance:
Y/N
If so, ist:
-Zo
M
Intake to complete the following:
Y /(�E)
Is use in LI, RI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y / �tiere Will 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/NG
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
llealth Dept. 11AX DATE
/ N
s on public water and sewer?
Y/N
Will you be putting up a new sign of any klmd? If so, obtain, proper Sign permit. KS� nSUI�Y�•�t
Permit #
re 6 r '3
Y /N@
Will there be any new constriction or renovations?
If so, obtain the proper Permit.
Permit # fro
l�
Is Y th/ is for sales of Fireworks?
If so, obtain a copy of F/R perni t.
Permit #
SP's
Y / )
If so('-'L ist:
10/14/05 Page 3 of 4
Reviewer to complete the following:
Square footage of Use:
Perm tted as: r � a . L G.,
Under Section: WL44t. Cal i vt,5.4•t ��--xLk64 %*VI' -e--
Supplementary regulations section:
Parking formula: (Furs'1 i S� re-�,j i - wwt, I /+ 90
Required spaces:
y / (
Items o be verified in the field:
Inspector Name & Date:
Notes
10/14/05 Page 4 of 4