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HomeMy WebLinkAboutCLE200600080 Legacy Document 2014-07-16/Li 1 J�` 11F :1L /Lea' p�plication for onin g Clearance OFFICE USE ONLY [Zoning Clearance = $35 CLE # --o© Co — 0 PLEASE REVIEW ALL 3 SHEETS Check# 691414 3 Date: 3-30'-0& Receipt # ,59A R S Staff: PARCEL INFORMATION Tax Map and Parcel: 0'4 5 (20 — OR-00 — 00/ Ofd Parcel Owner: Existing Zoning i4 W CAD r'Y1 /i) Parcel Address: 'dV 6M i 1161e. �� 'City t�' %�„'(c�f/f'SG>> I& State ry- Zip 22(?02 (include suite or floor) ` --------------------------------------------------- Al n � -------- - ---- - - - - -- ----------------------------------------- PRIMARY CONTACT Who should we call/write concerning this project? ` (_ e &j_.g 10 `4h�j ( C4 -F �r (� A � N AA n i Address :- I UCH() Q-t,r �. e ('1 Uc?� City t' I� i %l�r j (rgivu� State UAI Zip Office Phone: 43A! Cell # Fa�# i5 i - l� 9 E -mail - -- - -- -- ------ ---------------------------------------------------------------------------------------------------------------------------- PROJECT INFORMATION Business Name /Type: Fo" dA_h'er Ary- 9 hi. A( t3 c2 Previous Business on this site: 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 Cleara c will on 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 I understand them, and that I will abide by them. Signature / &� Printed Aa k .q- FX - -------- - --------- --------------------- -- ------------------------------------------------------------------------------------------------------ APPROVAL INFORMATION Vj Approved as proposed [ ] Approved with conditions [ ] Backflow 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 [ g site plan. [ ] This site complies with the site plan as of this date. gack}loW Device and/or .... m..V* "aft% Needed a , Building Official Date (� �� 1 o c. Zoning Of P i c Date �A 6/0 Other Official Date County 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 Applicant to complete the following: 0 4 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; 6 N 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. `) S -U - ;I ",r ( aA�-) Tech to comDlete the iolations: U /N sopk�� List: 2(e Z q O Y 55 W- CLE 2rd1 m (/l/2, .tv � Varli ee: Y/N If so Li Y If Intake to comple, ie following: Y /t:/ Is use to LI, HI or PDIP zoning? Engineer's Report (CER) packet. If so, give applicant a Certified Y Wi 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 Is 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 on public water and sewer? Y /X Wil ou be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Y Wi re be any new constriction or renovations? If so, obtain the proper Permit. Permit # Y Is is f sales of Fireworks? If so, obtain a copy of F/R permit. Permit # SP' Y/ If so, st: 10/14/05 Page 3 of 4 Reviewer to complete the following: Square Ifootage of Use: • �.Q.Q, n,GV� j " ' ; Y / N �j v'w ��j7/n " 4Dk Permitted as: g a5 iysws A &ROSi ,S,4A `f� �'� p��, ✓ r �� U, �•, 'D r nl sec -(1� Under Section: Z "/, 7 , 1 &4t e) Supplementary regulations section:: / Parking formula: !V - 1 3 0-ff • ee� = b Zb r1 _ fPA C Required spaces: Y/N Items to be verified in the field: Inspector Name & Date: Notes pwl j P 5,4 , plA 5oa� 10/14/05 Page 4 of 4