HomeMy WebLinkAboutCLE200600120 Legacy Document 2014-07-22Application for Zoning Clearance -
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F-1 Zoning Clearance G $35 CLI # l!
PLEASE REVIEW ALL 3 SHEETS Cheep of Date:
Receipt # staff:
PARCEL INFORMATION
T2x'»7ap anti Parcel: :J G l 2 u Existing Zonin f D 10 c
Parcel Owner: J h w pea 0-C 0 (j ve r- (�' Lj vl c L L C
Parcel Address: o ik Ir � a-( Law- ` City Cp a�
• inclade suite or floor
FRIMARY CONTACT -
Who should we call/write concerning this project?
State V /� zip 2� %32
................... •-•-------------------------- - -----
Address : 1T ' 00),� 12-2- City R-i, VI /f.- State
VA
! _ zip '2252- 4
Office Phone: ti T �%.S�d��S^j Cell 560'-e— Fax E -MAI
- - --- - --•• ... .............. ...•. .... .. _..--------------------------------------- .,--- --- •- -- - - - - -- -----------------
CT INFORMATiUN 11
Business Name/Type: 1 -�� (% -5
PreAoius Business on this site: nom
Proposed use:
Circle (if applicable).- Fireworks / Christmas Tree.
SEE CONDITIONS OF APPROVAL IF THE CLEARANCE IS FOR FIREWORK OR C*MSTMAS TREE SALES (Sheet 1)
"This Clearance will only be valid on tha parcel for which it is approved. If you charge, 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 acenrste to the best of m�ykmp wlcdgc. I have read the conditions of approval, and I understand then', and that I will abide by them.
signature ��V �{ I ! tom. ( 1. �1'� Printed
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APPROVAL INFORMATION - � _._�
[ ] Approved as proposed (`)(J] Approved with conditions ;LC � 0t0
[ ] Backflow device and/or current test data needed for this site_
No physical site inspection has been done for this clearance.
si plan.
[ ] This site complies with the site plan as of this date.
Contact.A,CSA 977 -4511, x119.
Therefore, it is not a determination of compliance with the existing
Backnow Device anal/or
Building Official. Date C.
c
IL
Zoning Official Date
Other Official C _ . �TT � Date
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unty o_Abemarle Depa mmu
n- - i- t-y
Deviftapment 4
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 10/14/05 Pa of 4
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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;
Q N
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 squam footage of the use and/or,
The squat footage of each room or area of use;
Use of each room or area
If using Jess than the entire structure, note the location within the
structure.
Tech to complete the
X/N
If so, List:
Intake to complete the following,
Is usin ( NJ
Is LI, HI or IaZ7TP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y)/ t N
Will there be food preparation?
If so, give applicant a Malth Department form.
Zoning review can not begi u ti eoivc approval from
Healltthh Dept- F. AX DATE
Y /O hl
Is p eJ l on private well and septic?
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from
4calth Dept. FAX )DATE
on public water and sewer?
yy N
ill you be putting up a new sign of tiny kind? If so, obtain
proper Si rm'
I'erm�lt #
X /(N J
Wili crc be any new construction or renovations?
If so, obtain tiro proper permit.
Perm
Is l(N)
Permit #
Is thss r saes of fireworks?
If so, obtain a copy of FIR. permit.
Permit #
crofters:
YIN
If so, List_
la- r r
NOW
'Y / N
if so, List;
YIN
If so List:
'SP. 206 l - 1(a ,. I��w lea•tth PD�1
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10114105 Page 3 of 4
Reviewer to Complete the following-
Square �5 ,
Square footage of Use: ! 'J �}
I/N
ermitted as: VyLellik
Under Section:
Supplementary rejibluIC)o ns section: -7
Parking formula-
Cr U oOR-- 14 p
Required spaces: % " /5�0� l 0 (�lW�
Y/N
Items to be verified in the field:
Inspector haute & Date:
Notes
4-� V-�5
10/14/05 Page 4 of 4
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