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HomeMy WebLinkAboutCLE200600115 Legacy Document 2014-07-220 . Zonis Clearance Application f ®r g k- OFFICE USE ONLY oning Clearance = S35 CLE # -b Oo to PLEASE REVIEW ALL 3 SHEETS Check #! Date: -15'-H-0 Receipt # rye Staff: PARCEL INFORMATION Tax Map and Parcel: 04 5C.0 w O3 -- p A - (.00 00 Ex ➢sting Zoning r�Y Parcel Owner-. " e'�°k d e N s 1 V Id State 1/`/� • Zi Parcel Address: 9 p G� � d,L City �. ` p.� -------------------------------- - - - - -- - - - - -- d ----------------- ,........ PRIMAR Y CONTACT Who should wecall/write concerning this project? R fl S t✓ 5�x-��- Address: l croo (rCtn. dt"S 31 v,, -� City C` lle. State \r A• Zip ,� `d�! -3y S a °yl yzc� q/� y �� 973— Office Phone: { 3) Cell # ax # E -mail .. - ............. -------------.-..._. ............................................... PI20,DECT >1NlFORMATI0 N Business Name/Type: 1 ? rA r- r, C e- Previous Business on this site: kA n -A-,Z. -5-t L& Proposed use•,. W S=F1 c.. e, Circle (if applicable): Fireworks / Christmas Tree. Y, SEE CONDITIONS OF APPROVAL IF THE CLEARANCE IS >'' OR FIREWORK OR CHRISTMAS TREE SAGES (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 1 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 II understand them, and that I will abide by them. Signature / � Printed I a 5� j , S�P�� e ----•---.,..- ................... °------------ - --- ---------------------------------------------------- I APPROVAL INFORMATION [proved as proposed { ] Approved with conditions [ ] Backflow device and /or current test data needed for this site. [+trKo physical site inspection has been done for this clearance. site plan. [ I This site complies with the site plan as of this date. Building Official Contact ACSA 977.4511, x119. Therefore, it is not a determination of compliance with the existing -- Date 6- 3 0 D C � - Other Official Date --- - - - - - - - - - - - - - - - ---------- - - - -,. — - - - - - - - - - - -- .-------------- - - - - -- .--------------------.-11------- County of Albemarle Department of Community Development 401 Mclndre Road Charlottesville, VA 22902 'Voice: (434) 296-5832 Fax: (434) 972 -4126 10/14105 Page 2 of Applicant to complete the following: -0 N Do you have one of the following? Tax Map and Parcel Number and or; Address of use (include unit or floor if appropriate; C-9 -9 I 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. Tech to complete the Y/ If s� V s ce: Y N If s L' : Intake to complete the following: Y Is ' L1, 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 riot begin until we receive approval from Health Dept. FAX DATE Y //g 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 N on public water and sewer? Y)f N VV'ill you be putting up a new sign of any kind? If so, obtain proper Sign permit. )Pertnit # Z i/N ll there be any new construction or renovations? If so, obtain the proper Permit, Permit # -�J. oo ioo©03ti AO- Y /(9N Is this for sales of fireworks? If so, obtain a copy of 1"/R permit. Permit N i Y SIN if AD c�s► Y If 10/14/05 Page 3 of 4 Fteviewer to complete the following: Square footage of Use: ermined as: qq r l A JP2 aRae) Under Section' Supplementary regulations section: Parking formula: Required spaces: � � � �` � /��� � � ✓ � � � /, / � /��� � G'Pi�G�" ��/,r��/�� Ct�dr✓r2,�•><�.� �J ?�� fa 'fLt.�.-� 0-��,..1� ItCMQ be verified in the field: aT Gr Cir�(1t 1�X Inspector Name & Date: Notes 10/14/05 Page 4