HomeMy WebLinkAboutCLE200600162 Legacy Document 2014-08-19.y .ii li r
Application for Zoning Clearance
OFFICE USE ONLY
E�foning Clearance = $35 CLE # zb "-
PLEASE REVIEW ALL 3 SHEETS Check # a- Date: -D
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: <_ , -' Existing Zoning I 1 C_
Parcel Owner: , F_ l psi t Lc L
Parcel Address: �n &,) � Cit jc a l =JC S{ ue State a Zip -a Z5 //
(include suite or floor) ---------------------------------------------------------------------------------
-----------------------------=--------------------- ----- - - - - --
PRIMARY CONTACT
Who should we call/write concerning this, project? - �`� 1�1! b \` >� -M i - C 1' 4
Address City i� 'v'��� State Zip/
J
Office Phone: �� >'� i.�rj 1''i�l��Cell # Fax # E -mail
------------------------------------------------------------------------------------------------------------------------------------------------
PROJECT INFORMATION q
Business Name/Type: ironti,N�avJ � ,c s: + rte �iScoc�R- 4. L(,C. Atf � FisZi�
Previous Business on this site:
Proposed use: bE:F 164Ly a.4
Circle (if applicable): Fireworks / Christmas Tree
SEE CONDITIONS OF APPROVAL IF THE CLEARANCE IS FOR FIREWORK OR CHRISTMAS TREE SALES (Sheet 1)
*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 tot of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed
---------------------------------- ------------------------------------------------------------------------------------------------- -------------
AP OVAL INFORMATION
[ Approved as proposed [ ] Approved with conditions
[ ] Backflow 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. BBCIOW DCVlCB >b� djpT
X 119
Building Official ` ..,,,. c. — e-- �=�- -� Date o C
Zoning Official Date g�a3 /ta6
Other Official Date
•------------------------------------------------------ - - - - -- - --------------- - - - - -- ------------------------------------------------- - - - - -- -
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5 2 Fax: (434) 9 4126 10/14/05 Page 2 of 4
Applicant to complete the following:
V oN
you have one of the following?
Tax Map and Parcel Number and or;
Address of use (include unit or floor if appropriate;
C N
Po 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.
Zoning Tech to
0/lations:
Y/N
Vf so, List:
Vari e:
Y /W
If so, List:
the followin
Intake to complete the following:
Y,/ N
Is I, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y
Wil ere 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
Y
Is par 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
public water and sewer?
Y /�
Wi be putting up a new sign of any kind? If so, obtain
proper Sign permit.
Permit #
ill re be any ne construction or no atio s9 6 LJ
If so, obtain the proper Permit.
Permit #
/
Is t l�sales of Fireworks?
If so, obtain a copy of F/R permit.
Permit # 4Y
Proffers:
Y /6st:
If so,
SP'
Y/N
If so, ist:
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