HomeMy WebLinkAboutCLE200600081 Legacy Document 2014-07-16L111q
Application for Zoning Clearance
❑ Zoning Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
PARCEL INFORMATION!))�� /� /~� �-�c� ,)
Tax Map and Parcel: Y l� A.A. -_00 -00 -M-5, ot-/
Parcel Owner: T O r eS 1-a k es _,5_4 oL
OFFICE USE ONLY ll —6m e
CLE # Nffi�
� Ot AryF,!
..........$
Check # Y Date:
Receipt # Staff: Inn I=
Existing Zoning D 6C
1770 � ►tad er w0 � s�e,po3 y Ly/a�e �d�'s V r 41 °l State V14- Zip
Parcel Address: � Cit
---------- - - - - -- (include suite orfloor)-------------- - - - - -- ---------------------------------------------- - - - - -- ------------------
----•----- - --------------- -
PRIMARY CONTACT q,� '�
Who should wee/call //write concerning this project � � /? / _l d f c- Av O
Address C City C ai_/ofV1 [1 _ Zip q
d3 � V/A-
Office
Phone: 3 y l-7 / r 7y q1 Cell # (11q )W o -0Y Fax # E -mail
-------- - - - - -- ------------------------------------------------------ - - - - -- Glao • Ccr�,
- ----------------------------------------- - - - - -- -- ---------------
PROJECT INFORMATIO
Business Name/Type: C- Oh 1;S", fti eti ,L I ee le- w ar(C s4ap
Previous Business on this site: /V
Proposed use: heal 1 '
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 my knowledge. I have read the conditions of approval, and I understand them, and that II will abide by them.
Signature) �Y1'+L Printed alro, ewusX Va
- - - - - - - - - - - - - -------------------------------------------------------------------- - - - - -- -------------------------
A-- PPROVAL IN__ F0__ RMATIO
[✓TApproved as proposed [ ] Approved with conditions
[ ] Backflow device and /or current test data needed for this site.
[PT No physical site inspection has been done for this clearance.
site plan.
[ ] This site complies with the site plan as of this date.
Contact ACSA 977 -4511, x119.
Therefore, it is not a determination of compliance with the existing
and/or
119
Building Official Date lei E
Zoning Official Date
V9MUFF �- -0� Date �6
'---------------------------- - - - - -- -�- - -- "en - - - -- - - - -- -- - -----------------------------------
Cou ty of Albemarle epa f Communi 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:
o
o you have one of the following?
Tax Map and Parcel Number and or;
Address of use (include unit or floor if appropriate;
Y 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.
Tech to complete the
Vio s:
Y N
Ifs Lis .
V
Y
If
Y
If
Y/
If sa
Intake to complete the following:
Y /�Is us in LI, HI or PDIP zoning?
Engineer's Report (CER),,packet.
If so, give applicant a Certified
Y /
Will there 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 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
son 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 /
Will ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Y /
Is th or sales of Fireworks?
If so, obtain a copy of F/R pen-nit.
Permit #
10/14/05 Page 3 of 4