HomeMy WebLinkAboutCLE200600123 Legacy Document 2014-07-24�'
Application for ��
Zoning Clearance (& ad-L�
199
[ ZZoning Clearance = $35 J
n ,
PLEASE REVIEW ALL 3 SHEETS Y� 0_/l Q—.-�
Tax map and parcel: 04 00 0Q L% l� ,:S /� � Existing Zoning: J -JQ 4A_) V� 1f M YYJ
Parcel Owner: ' - sG n
rn G 1 000-0-
Parcel Address: l _ / 6 4411ty C h �F(,.e.Jlt State' ZipG- 2! 0%
(include suite or floor) L/
Contact Person (Who should we call/write concerning this project ?): ` N) 14 j ��� 7 - V_ 1 fl
Address 956- 7YQEFF -6064 DPI- City F►-Uv� Q State Ila Zip 24?6_
Daytime Phone ( ) CL4 - <)&XX Fax # (_q.�J) _rI �� (r) 39 E -mail
Business Name /Type: i kVttV1Y►/i l C� . �� f C '�j� �►��C% t 8 Vla
Previous Business on this site:
Proposed use: C l 1Z W,A 5 0 —r 5 61L W [ My AU Ui, ( 5", 200&
SEE CONDITIONS OFA'PP.ROVAL IF THE CLEARANCE IS FOR .FIREWORK OR CHRISTMAS TREE SALES (Sheet 1)
Circle (if applicable): Fireworks / Christmas Tree
*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. accurate to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will
abide by them.
. ��, �� �,L -
��ZzloL�
Si atul f Business Own r or Agent Date
Print Name
L-►1Q0 g57-A f i orb - ULAR L-L
APPROVAL INFORMATION
Approved. as proposed [ ] Approved with conditions
[ ] Backllow 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 determination of compliance with the existing site plan.
This site complies with the site plan as of this date.
Building Official Date G � O ( n
Zoning Official Date 9 —23 —o4
Other Official Date �'� - 2,6 • P6
FOR OFFICE USE ONLY CLE # 20010-/07,3 ,1 tt�,' I
Fee Amount jOd Date Paid -x5 Z By �� ho7 _p Receipt # �i0 /oZ' l Ck# 7C�`7 I3y:
;!�tlrE
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 5/1/06 Page 2 of4
Applicant to complete the following:
Do you have one of the following?
[YES ❑ NO
Tax Map and .Parcel Number and or;
ZF-] f use (include unit or floor if appropriate)
NO
Do you have a Floor. Plan (sketch or ,ui 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
Violations:
❑ YES ❑ NO
If so, List:
Variance:
❑ YES ❑ NO
If so, List:
the
Intake to complete the following:
❑ YES ❑ NO
Is use in .LI, .HI or PDIP zoning? If so, give applicant a Certified
Engineer's RXepCER) packet.
❑YES
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. FA DATE
❑ YES NO
Is parcel. on private well quid septic?
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from
rYES cpt. FAX DATE
❑ NO
Is on public water and sewer?
❑ YES 0
Will you be putting up a new sign of any kind? If so, obtain
proper Sign permit.
Permit #
❑ YES P NO
Will there be any new construction or renovations'?
If so, obtain the pro er Permit.
Permit #
❑ YES NO
Is this for sales of Fireworks?
If so, obtain a copy of F/R permit.
Permit #
Proffers:
❑ YES ❑ NO
If so, List:
SP's:
❑ YES ❑ NO
If so, List:
5/1/06 Page 3 o f 4
C:
ReV!,ewer to complete the following:
Square footage of Use:
P,-V'ES ❑ N -
Permitted as:
Under Section: A u IKI VJbYIi�
Supplementary regulations ection:
Parking formula:
Required spaces:
❑ YES ❑ NO
Items to be verified in the .field:
Inspector Name & Date:
Notes
5/1/06 Page 4 of 4