HomeMy WebLinkAboutCLE200600084 Legacy Document 2014-07-16Application for Zoning, Clearance
OFFICE USE � ��� � � J,
❑ Zoning Clearance = $35 CLE # pp��22�� ``!
PLEASE REVIEW ALL 3 SHEETS Check # _ -� Date:
Receipt # , ' L Staff:
PARCEL INFORMATIO
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Tax Map and Parcel: Existing Zoning
Parcel Owner: J L 4 l �d
q4 3 G lenwooA S- &AVt A 0v � �r
Parcel Address: ity C' (o �f��ri /�Siate
(include suite or floor)
14 Zip Z2 o /
PRIMARY CONTACT
Who should we call/write concerning this project?
Address • 15 a `1 l3 �N5 U YGvn crL LA City M Svi / {State V14- Zip Z— 2 f 0
Office Phone: LL01) 4 17 a 395 Cell # 9 9 05'C�O Fax # 5.Z& 49- 9 7 E -mail >`� S GZ Vic �C %l2f/�2LZ
PROJECT INFORMATION
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Business Name/Type: i e GZ(
Previous Business on this site:
Proposed use: g a le
tq <9 K)
D °i'
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 owners permission to use the space indicated on this application. I also certify that the information provided is
true and accurate the best of my knowle e. I have read the conditions of approval, and I understand them, and that I will abide by them.
L
Signature �' U�—e Printed J>/
APPROVAL INFORMATION
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
site plan.
[ ] This site complies with the site plan as of this date. awknew MAW swe
'feat Data Nmded
Building Official Date
A
Zoning Official Date
Other Official Date
ounty of Albemarle Depa ent of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 10/14/05 Page 2 of 4
V_ , L i
Applicant to complete the following:
/ N
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
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.
, oning Tech to
Vio ns:
Y f N
If s , st:
Var lon e:
Y N
If
Intake to complete the following:
Y /0
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
/
Will Y 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 p cel 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
%Y/ N
s on public water and sewer?
Y/
Will ou 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 thi or sales of Fireworks?
If so, obtain a copy of OR permit.
Permit #
the following: P/ ® SIO I #\j ,C4
Pro
Y/
SP's:
Y / (.
If so,
564 1 — Ann,e -44-u, lu, tv 3 (�
10/14/05 Page 3 of 4
Wviewer to complete the following: 3 ® 0
Squaresfootage of Use:
T r ,e N
mitted as: 44�
Under Section: 9,0 A G a% d'' a•1 1 1
Supplementary regulations section: _ ✓►'�D�>
Parking formula:
Required spaces: Y itV � �dYbc+� dhyp -Pc c Cf-�-
aT bE verified in the field:
Inspector Name & Date:
Notes
Page 4 of 4