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HomeMy WebLinkAboutCLE200600132 Legacy Document 2014-07-24fl ,' jb Application for Zoning clearance Zoning Clearance = $35 PLEASE REVIEW ALL 3 SHEETS Tax map and parcel: 0 L4 & 62 D / —100 r 00,506 Parcel Owner: f/V // I'%�i . 5/ �(/ z� � z Parcel Address: � �J /�, 5(4w & C .Q _. City (! (include suite or floor) Person (Who should we call/write concerning this project ?): (Daytime Phone Business Name/Type: W 0 r # �� 6r �� Z !J U. L/ E -mail %(�Ql K1�i� �%t C�%7 /` 1d Previous Business on tll Proposed use: �✓ l�� C SEE CONDITIONS OF APPROVAL. 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 em. Si tore of Business Qwnq or Agent Date D )n Print Name APP OVAL INFORMATION [ proved as proposed [ ] Approved with conditions [ ) Backflow device and/or current test data needed for this site. Contact ACSA 977 -4511, x119. [CNo 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 �S Backitaw Device and/or Zoning Official Date 7 ob t Data de Other Official Date FOR OFFICE USE ONLY CLE n# �©�d Fee Amount $ 0Lt Date Paid J-31'd 0 By who? .I) l ff'� 19 L 0— Receipt # &Q01 V � Ck# o- Jc- % d By: County of Albemarle ]Department of Community Development 401 McIntire (toad Charlottesville, VA 22902 Voice: (434) 296 -5832 ]Fax: (434) 972 -4126 511106 Page 2 of 4 Applicant to complete the following: Do you have one of the following? ❑ YES ❑ NO Tax Map and Parcel Number and or; Address of use (include unit or floor if appropriate) BYES ❑ NO 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. %ping Tech to c Violations: ❑ YES / NO If so, List: Variance: ❑ YES dNO If so, List: the Intake to complete the following: ❑ YES [ 1NO Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. ❑ YES [9/NO 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 [:1 YES L1u. 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 D�t. FAX DATE N • Is on public water and sewer? ❑ YES ['NO Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # ❑ YES - NO Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # ❑ YES O Is this for sales of Fireworks? If so, obtain a copy of F/R permit. Permit # Proffers: ❑ YES 2NO If so, List: SP's: ❑ YES NO If so, List: 511106 Page 3 of 4 Reviewer to complete the following: %YP Square footage of Use: 9 1 251 [YES ❑ NO Permitted as: Under Section: Z A Supplementary regulations section: Parking formula: ax; v1 4 P-� ( ( ' Required spaces: 01 U ! `i r ( ( I r(1 A NT ❑YES NO �"'" ' ` Items to be e� C4 Cis-4991 f' ied in the field: Inspector Name & Date: Notes 5/1/06 Page 4 of