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App ic flan for Zoning Clearance
N Zoning Cleam ace = S35
PLEASE REVIEW ALL 3 SHEETS
PARCEL INFORMATII3N
Tax Map and Parcol:(2 v —61 — 04-0c'
...Parcel Ovirmer: (rFr-eA6 ! f e [—
OFFICE USE (3lelLY
CLE 0 7-too U= 1.0 C�
Check# j/ �p Date: -Z -OCd
Receipt # �r X17_ 7— Staff:
-d hL �
'-ftl -oo4s
'P2 reel Addrfts: Cite C G��Iv { D ?�tf Gate V _ dip
ji�ichce suite. or floor) - - -----------r-- ---------- ---- --......._.,L 1111_ .- - - - - -- - - - -.,_,_1.11.,.1
P]IiYMC I2Y C 1�' I ,ACT ro 11+LCQ_0 c1 C , l v� t' e �`c� W� ' -(
Who should we call/Write concerning this prrojeet. —i _ �1
Address, q(6 [a i° o NClty C��1�� s�,�/ tote•— zip ? 0
Office Phone; 631b '? ?Y--0 Coll �€. � Ii���S- _ Fax # �5 y J .� - -- E -Fnail CT-a-(-Cg C A
PROJECT INF'ill�'�A'I:'Ii) N
/ ---------------------------------
Business Name/Type: GV� V �- ------------------------------------------------------ 4 �v�tu6w`*q, t {�/�G!v A/� f � t
Previous Business on this site:
<-.-4 n C '0-
It o
Proposed e: c;✓�- re�w ✓sP� /N� C, -� `�-�
Circle (if a{•+plicable): Fireworks / Christmas Tree
SEE CONDITIONS OF APPROVAL IF THE CLEARANCE 1S FOR F1RrL -W0V C O, CHRISTMAS TREE SALES (Skeet 1)
$This Meatxvioe will only be valid on the parcel for which it is appioved, if you chmge;-int:nsify or me.- o lfie list to a nny location, a new Zoning
Clearance •wilt be required.
T heroby certify that 1 Wtl or have the owner's -iss' to use die pace hidicated on this application. i also ceilify that the information providrd is
true and acoamw' to best of nay knowledge hav e d4he-mMitions of approval, and I understand then, and that t will abi by than.
Sigrta'ture _ Printed"
APP
C--- -- -, INFORMATION
h�T -.. , _1111.. w.- -- .------------------------ - - - - -- ---- --. -.. -------------------- - - - - -- ........
proved as proposed [ Ap:-pro'ved with conditian,
[ 1 Sac flow device and/or currant test data needed for this site, C-ontaO ACSA 977-4511, x1 19,
[ o physical site inspection has been done for this clearance. Tl;erefore, it is not a determination of'compli<mce Auith the existing
site plan.
[ T11is site complies with the site plan as of this date.
ackftow Device and/or
-feest _ 45131 x f ig
Building Official s Date
Zoning Official � Date iG � • D �o
Other Official
Date,
-
-------------------------------------------- - -- 1111... - - -... - - -- - -.1111-11- -----------------------
County of A.Ibemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 V•oide: (434) 296 -5832 F ax.; ,(434) 972-4126 1 U /14 /US Page 2 of
900/600d =89' l l- 9007 L 42A 961lVZL6V'V xn� ilN31Yd0�3A3Q hl.l �1tlYald0�
r
Applicant to con1lpicte the following:
y / N
Do you have one of the followhioO
Tax Map and Parcel Number and or,
Address of use (include unit or floor if appropriate;
N
o you'have a Floor plan (sketch or an ai chji ecturai drawing;) that
includes the following„ aatd if so please provide it with the
application?
The total square footage of the use and/or; Of-d'G �.tvo\ I 11
The squta,e footage of eaeh room or area of use,
Use of each room or area
If using less than the entire structure, mate the location within the
6truot1 rc'
3Oa Ot S f'
_)NCV4
� k �
;on -ing Tech to complete the following.,
Vto a: _ .�
y/
I
f so ' ist-
anc'e:
N
Intake to complete. the following:
Y'( .
Is use m LI, HI or PDIP zoning?
Engineer's Report ("ER:) packet.
If so, give applicant a Certifies!
y /
Wi ere be food. preparation?
If so, give applicant a Hca.lth Uepartrnc'nt form.
Zoning review can not begin until we receive approval from
Health Dept, FAX DATE _
Y it
Is parcel on private well and septic?
if so, give applicant a Health ]department form.
Zoning revieNv can not begin until'wc receive approval from
Health Dept, FAX ]DATE
/ lV
on public water and sewer?
y/N
Will yoit be putting up a now sign of any kind'? if so, obtain
proper Sipapermit
Permit # / V' � ,tom
Y 11 Y l I
Y/N
Will there he any new construction or renovations`? j
If so, obtain the proper permit.
P';rtnit # - Pp//�- ,�
y/tp
Is this for sales of Fireworks?
If so, obt,3.iti a copy of.P /k permit.
Permit #
VY ( l�N'
a3. JP,644, .1St:
qql
10114105 Page 3 of
900 /UOOd 069!44 9002 4 hplt KI.VURE? xad UN3NdOIA]a ALIN woo
u
o — V
Reviewer to complete the foil" ing:
Squm footage of'Use: — — _-
Y
hied as; - -,--
Uhder Section:
Supplementary regulations section: �jrj� _ __•
Parking forinula: zz"r,
Required spaces: _—
Y�
here Ut verified in the field: _
Inspector 1WAane & Date.
Ndte&
1 0114105 Pa.Re 4 of 4
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