HomeMy WebLinkAboutCLE200600158 Legacy Document 2014-08-13b /d 4
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Application for
Zoning Clearance
i E]l'oning Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
Tax map and parcel: <? r 316— Existing Zoning: jpac,
Parcel Owner:
(ON >2�' 1
Parcel Address: �. �LS:� Sti ��
(include suite or floor)
�1 ®y+
State A, Zip d.�,q
Contact Person (Who should we call /write concerning this project ?): �G -���� _J_ 3
Address _ (O t �( �' 7 �r/+�v� W�� I1 lye City Cam. r10 SVti� e` -, f Staate_ Zip 2-2-9 11
Daytime Phone �y��. -�,�qS Fax #L� E -mail C�fW •y��'V1P�avx"Jid.'S,CtM�
Business Name/Type: ._L L "— ; _ WC,
Previous Business on this site:
Proposed use:
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 anew 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 -
Owner or Agent
Print
APPROVAL INFORMA
[ ] Approved as proposed
[ ] Backflow device and/or current test i
[ ] No physical site inspection has been
[ ] This site complies with the site plan
Date
ED
] Approved wi i- of nditions `
needed fo this site. Contact ACSA 977 - 4'511, x119.
for thi arme T ierefore, it is not a determination of compliance with the existing site pl
'this -d•
Building Off ial _ DAte
Zoning Off cial / 'Date � 23 0.6
Other Offi ial Date
FOR OFFICE i #
Fee Amount $. 7 Date Paid By who? M JaI36 E.Z Recetpt "# 1pQ599 Ck# /00 By:
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:
L
Do you have one of the following?
XYES ❑ NO
Tax Map and Parcel Number and or;
Address of use (include unit or floor if appropriate)
RYES O
Do you hav loor 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
struct e.
Der Cii v
his �w.r��s��Q a� 0n2,99
'his S�r�� �� la�.�:�� ►ns��e. su;���.
\J
: oning Tech to c
Violations:
❑ YES ❑ NO
If so, List:
Variance:
❑ YES ❑ NO
If so, List:
the
Intake to complete the following:
❑ YES NO
Is use in LI, or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
❑ YES NO
Will there be od preparation?
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from
Health Dept. FAX DATE
❑ YES NO
Is parcel on p ate 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
YES F-1 NO
I n public water and sewer?
❑ YES NO
Will you be p ng up a new sign of any kind? If so, obtain
proper Sign permit.
Per nlit #
❑ YES NO
Will there b new construction or renovations?
If so, obtain the proper Permit.
Permit #
❑ YES O
Is this for A�f F ireworks?
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 of 4
A�
Reviewer to complete the following:
Square footage of Use:
DIIES ❑ NO
Permitted as:
Under Section:
Supplementary regulations section: - (/
Parking formula: I / o .o d
Required spaces:
❑ YES ✓ NO
Items to be verified in the field:
Inspector Name & Date:
I Notes
5/1/06 Page 4 of 4