HomeMy WebLinkAboutCLE200600163 Legacy Document 2014-08-20.,Application for Zoning Clearance
❑ Zoning Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
PARCEL INFORMATION
=1=
OFFICE USE _W / / -V
Check # Date:
Receipt # t. Staff:
Tax Map and Parcel,./
!,(��r' ,� - Vd b �j ��� Existing Zoning /`rte
Parcel Owner: A, 7, 1 `,1A-14�'
//�� �j /l f State ZiR =l`�f
Parcel Address: �flor! (incl ude suite or ------- - - -- -- -------------•------•---•-
--------- -- - - - - -- ---------------
PRIMARY CONTACT
Who should we call/write concerning this project?
Address : �dz5 �KTD i�d City G lC ✓�� QsVI %1e State VA Zip '�i'L9t1
Office Phone:
- q 7 j- J 3 k Cell # Fax # E -mail
-- - - - - --
PROJECT INFORMATION
Business Name/Type:
Previous Busir
Proposed use:
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 owners permission to use the space indicated on this application. I also certify that the information provided is
true and accurat to the best of my knowl dge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature
' PrintediG����
APPROVAL INFORMATION [ ]Approved with conditions
Approved as proposed
[ ] Backflow device and/or current test data needed for this site. Contact ACSA 977 -4511, x119.
�Io 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 Z C o
c
Official Date W-
Zoning �
Other Official Date
..................... .
Co my of Albemarle Departmen�iC
om munity Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 10/14/05 Page 2 of 4
Applicant to complete the following:
Y / N
Do you have one of the following?
Tax Map and Parcel Number and or;
Address of use (include unit or floor if appropriate;
Y/N
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.
Zoning Tech to com
Viol ins:
Y/N
If so, List:
Vari nce:
If oyist:
the
Intake to complete the following:
Y /v
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y I(N)
Will ih 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 /N0
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
I/ N
on public water and sewer?
Y /
Pyou
Wil you be putting up a new sign of any kind? If so, obtain
proper Sign permit.
Permit #
Y / fN1
Wil ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Is th
Is or sales of Fireworks?
If so, obtain a copy of F/R permit.
Permit #
Proffers:
If o;-List:
SP's,
If so, List:
10/14/05 Page 3 of 4
Reviewer to complete the following: C ^ ^ n
Square footage of Use: sek
n
/N I
ermitted as:
Under Section: t
Supplementary regulations section:
Parking formula:
Required spaces:
Y/
Items o e verified in the field:
Inspector Name & Date:
Notes
10/14/05 Page 4 of 4