HomeMy WebLinkAboutCLE200600088 Legacy Document 2014-07-165i s C OF A
1
Application for Zoning Clearance
'. ;i `IRGINIP
OFFICE USE ONLY_ Zoning Clearance = $35 CLE # (0 — S
PLEASE REVIEW ALL 3 SHEETS Check # .� y Date:
Receipt # Staff-
PARCEL INFORMATION
Tax Map and Parcel: _Q�(,(J
,Parcel Owner: 6
)9M 0, 6(/;s
Parcel Address: `76 AV/ 0-1�
(include suite or floor)
APPLICANT INFORMATION
Who should we call /write concerning this project? _
Address: 3 Z go %i�Este.)Jr-'e
'fib y -30 - o
Da Existing Zoning 4C-11
7 i "City � �— V�4-66 4 State Zip
----------------------
City kC 60 IC t State Q A Zip Z z'9
Office Phone: n-2_96 66 3Z Cell # 96_,�' 9l 75 Fax #
E -mail
------------ - - - - -- Tb -- ------------------ �NKNW& ----- ---------- - - - - -- --
-- --------------------------------------
PRIMARY CONTACT
Business Name/Type: � U ltr.t d A
Previous Business on this site: �� �� ✓� �� C,�Q S�1
Proposed use: `�(L�Y�C �it,%-t'7t`✓9 `,1.. - ../7(lciU`�%�
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 wn or have the owner' ermission to use the space indicated on this application. I also certify that the information provided is
true and accurat o st of my knowle I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed �% 0..
- --- -- -- - -- - -- L__-----------------------------------------------------------------------------------------------------------------------------
APPROVAL INFORMATION
Approved as proposed [ ] Approved with conditions
MNo physical site inspection has been done for this clearance.
site plan.
[ ] This site complies with the site plan as of this date.
Therefore, it is not a determination of compliance with the existing
Building Official "� A= �� Date S, � is
Zoning Official � - Date 3�2(�0�
and /or
19
Other Official 4 Date
- - -- - -- - - - - - -- - - -- - -- - - -- - - - - - - -�� Z- -------------------------------------- - - - - --
County o Albemarle De ar ment of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Applicant to complete the following:
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;
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 /N
If s , Li t:
Vari ce:
Y/ ELNN
If so Li t:
the
9/28/05 Page 2 of 4
Intake to complete the following:
Y/N
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
Will 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 /lg
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
Y
on public water and sewer?
Y/.8
Will you be putting up a new sign of any kind? If so, obtain
proper Sign permit.
Permit #
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Y/0
Is this for sales of Fireworks?
If so, obtain a copy ofF/R permit.
Permit #
Y/
If sc
SP' .
Y/
Ifs st:
Reviewer to complete the following:
Square fbotage of Use:
Permitted as:
Under Section:
Supplementary regulations section:
Parking formula: I2tA I' """ �
Requir d spaces:
Y N
Ite s o be verified in the field:
Inspector Name & Date:
Notes
y %L2S /UJ Page 3 of 4
3/28/05 Page 4 of 4