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HomeMy WebLinkAboutCLE200600161 Legacy Document 2014-08-19I�I�X Application for Zoning (clearance Y� loj Zoning Clearance = $35 PLEASE REVIEW ALL 3 SHEETS Tax map and parcel: 0 4 5CO 00-06- 60 S OO Existing Zoning: HQ W Y co n r1�%i Parcel Owner: Parcel Address: d" ,50 Jo mflo l _ �� City (include suite or floor) State VA Zip d0 Contact Person (Who should we call/write concerning this project ?): vl ODO C ` _ G QA-V r 1 Address'V . C) { e)(7 /� \ 2 9 o rl c City \�►Q,W� uY ` 1 " l W S State (Zip oC c Daytime Phone �` `Q l Q Fax # ( >` !) ! 7 "W q :5 E -mail l�f Q e 5&' aAAm V em,e U Business Name /Type: �(�J Previous Business on this site: Proposed use: ` oor =11M 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 by them. cis I c)(0 Signature of Business Owner or A 911ER Date Print Name APPROVAL INFORMATION Approved as proposed [ ] Approved with conditions [ ] Backflow device and /or current test data needed for this site. Contact ACSA 977 -4511, x119. pC� 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 c. Date-( va paclaw r1rW&M ma Zoning Official Date t Other Official V Date Contad A 9M41914 ,7I 119 FOR OFFICE USE ONLY CLE # Z0049- Fee Amount $ UCH Date Paid -7 , By who? P_Al '1-qr pA 1�2D Receipt # ddb Ck# /© 59 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 of 4 Applicant to,,complete the following: Do you have one of the following? )YES F-1 Map ax Map and Parcel Number and or; Address of use (include unit or floor if appropriate) ❑ YES NO Do you hav a 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 structure. �,�\ ,� r pS R(2-x) V _ ra ealo -s w'� vwe coning Tech to c Violations: ❑ YES NO If so, List: Variance: ❑ YES 0 NO If so, List: the Intake to co ft the following: ❑ YES O Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. ❑ YES [D 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 ❑ YES [+NO 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 YES ❑ NO Is on public water and sewer? ❑ YES D NO Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # ❑ YES E]/NO Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # ❑ YES [! 40 Is this for sales of Fireworks? If so, obtain a copy of F/R permit. Permit # Proffers: ❑ YES NO If so, List: O� SP's: ❑ YES M NO If so, List: 511106 Page 3 of 4 Reviewer to complete the following: a a Square footage of Use: U -YES ❑ NO Permitted as: j/V1O�'Or V�IC G%e,(e5,5erylC,e, r r�,,/�{�,► Under Section: �� • a • �a'``'� Supplementary regulations section:: / Parking formula: f/ ��d L6 i 5� 64*`f_ ew<a Required spaces: 16.4e Zl ❑ YES O Items to be verified in the field: Inspector Name & Date: Notes 5/1/06 Page 4 of 4