HomeMy WebLinkAboutCLE200600165 Legacy Document 2014-08-20Application for C ) e o to - -�
Zoning Clearance
Zoning Clearance = $35 eel-
PLEASE REVIEW ALL 3 SHEETS S+CL�►d 0_11
Tax map and parcel:, I r6 � 3 �� ' Existing Zoning: _ - �— ✓
Parcel Owner: V IRc"(10lA - p
Parcel Address:�� Q L] ?k RD City J- V 1 State I/ A Zi1D Z ?qS
(include suite or floor)
Contact Person (Who should we call /write concerning this project ?): Nl Vf` K►��t
Address ')irXl 1 iNit/it1V 7 Sviltl 201 P &X Lgt7City Lf71yE'fi0iUC State Zip 2,zqQ2
Daytime Phone ( ) �7 by i L/. (o Fax # (aqj LL6- L 2L E -mail
Business Name/Type: "�� MfiM &- 0)J' Nti7o F 10 6E LW LsEL %!
Previous Business on this site:
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 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.
Lot,
Signature of Business Owner or Agent Date
R, k6lAe,5
Print Name
APPROVAL INFORMATION �f
[ ] Approved as proposed [A Approved with conditions ,, t MV.—E r_n
�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
rJThis site complies with the site plan as of this date.
Building Official Date 0
Zoning Official Date 7/7 6
Other Official Date
FOR OFFICE USE ONLY CLE # Z060 9
Fee Amount $,55,0 d Date Paid �By who? ✓a LA .416L q p i r eipt # . to 77 Ck# � M 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
i
i
Applicant to complete the following:
Do you have one of the following?
VYES ❑ 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
structure.
Zoning Tech to complete the
Vi Oations:
YES ❑ NO
If so, List:
Variance:
❑ YES [A NO
If so, List:
Intake to complete the following:
"S ❑ NO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet. Jr A >4 e&, - & -,9 7 -04
❑ YES El"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 De t. FAX DATE _
Is parce o to well a ic? ��
so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from
Health Dept. FAX DATE !2-:5-6(r2
S NO
Oosn public water and sewer?
y
❑ YES [�TO
Will you be putting up anew sign of any kind? Ifs obtain
proper Sign permit.
Permit #
❑ YES ff*'NO
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
❑ YES aNNO
Is this for sales of Fireworks?
If so, obtain a copy of F/R permit.
Permit #
Proffers:
❑ YES N NO
If so, List:
SP's:
❑ YES _W NO
If so, List:
5/1/06 Page 3 of4
Reviewer to complete the following: c-
Square footage of Use: ..�J��U✓ `-
eP rmitted a � N `
Under Section: Xq , 4, 1 ( 17 )
Supplementary regulations section: /
Parking formula: < �(SO l �P
� �b /.Prl�j�c�e� �- ihevl• �'�'� -�d
Required spaces:
❑ YES ❑ NO
Items to be verified in the field:
Inspector Name & Date:
Notes
511106 Page 4 of 4