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HomeMy WebLinkAboutCLE200600112 Legacy Document 2014-07-22�117 pF M.l7�./1 ^.G Application for Zoning Clearance '- OFFICE USE ONL, Zoning Clearance = $35 CLE # Zf� PLEASE REVIEW ALL 3 SHEETS gbwic # SI g Date: S--! 5� D Receipt # Staff: b0F2 PARCEL INFORMATION Tax Map and Parcel: X may) 17. ()(:1� al 110 Existing Zoning p DS C P.arcelOwner :— `IiaYIA - £ �hLK5TMa C (1 Parcel AddressM i city C 1Lx 76 C4 'Jul k State u f 1 Zip (includes o- ) - - -- ------------------------------------------------------------- - ----------------------------- ite or flo------------------ - r PRIMARY CONTACT Who should we call/write concerning this project? 9 Address : 1�� tN c h Sf City State �C Zip ��3Q Office Plione: (7W)SIG -4M i ell # "- Z 9 Fax # '3q 9bE-mail e 1X-JG1LJA Q.Q Vdt1Gtat11W(4, At� --- ---------- ------------ ----------------------------------------------------------------------------------------------------------------------- PROJECT INFOP4ATION Business Name /Type: Adw d Previous Business on this site: 1 i ( (,Ae I me- L11W Proposed use: Vowdew o hda - li'1U1i a f�5(auict- imt)S 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 ac rate to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them. Signatur Printed 1 4f_ - ()p2Ka� --------------------------- - - - - -- o_1,1i'_1q -- & qr- QS- - Mw -- --- 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 detennination of compliance with the existing site plan. [ ] This site complies with the site plan as of this date, p and/or acMIOMW nt Test L1111 11 119 rSA • Building Official Date -� Z � c Zoning Official Date ri 6 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 4 Applicant to complete the following: OY /N Do you have one of the following? Tax Map and Parcel Number and or; Address of use (include unit or floor if appropriate; Q Q �J / N 0 you have Floor Plan )ketch or an architectural drawing) that includes the fo owing, 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. 1,0, W;►Il bA a- 4mn% � U(j h PlOqS Shri n9 0 Mtn— Zoning Tech to complete the following: Vio ons: Y/ If Li ariance: Vs N so, List: VA la H ds Intake to complete the following: Is/ Is u n LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y/0 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 /GN 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 I/ N on public water and sewer? 9 Y/N ill you be putting up a new sign of any kind? If so, obtain proper Sign ermit. Permit # ©/ N Will there be any new construction or renovations? If so, obtai the proper Pe it. Permit # 0-0 U YO Is this for sales of Fireworks? If so, obtain a copy of F/R permit. Permit # 71K. �1120 YY N -I so, List: Y;Qrrr�ss�ir►• FEE 10/14/05 Page 3 of 4 Reviewer to complete the following: B W Square footage of Use: Y / N Permitted as: -! �/1/�(.(/►�Q.c r� l/VL 5'�I Under Section: Supplementary regulations section: CV141, Parking formula: Required spaces: Y/N It is to - verified in the field: Inspector Name & Date: Notes 10114105 Page 4 of 4