HomeMy WebLinkAboutCLE200600166 Legacy Document 2014-08-20Application for Zoning Clearance,;�_,::�t�
OFFICE USE ON
[Loning Clearance = $35 CLE #
PLEASE REVIEW ALL 3 SHEETS Check # / Date:
Receipt #. (O Staff:
PARCEL INFORMATION
Tax Map and Parcel: J ` ( `' Existing Zoning !� ,
Parcel Owner: V Y 4T 1 N ( A LAN 1b "" 3T_ r
r. Gj
Parcel Address: D 5 City l ,� U • I e State Zip � (%l
(include suit or floor)
PRIMARY CONTACT f � n "�� ®T � •-��
Who should we call/write concerning this project?. 'VA_ � ��
Address
ac]- Vll -fU City l./ l�l o ill State Zip G -7Q Office PhCell # Fax # �Y� E -mail %A1/�1__)L
PROJECT INFORMATION
Business Name/Type: l 1�1 ins IA-)
Previous Business on this site:
Proposed use:
7
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 at I own or have the owner's pe 'ssion to use the space indicated on this application. I also certify that the information provided is
true and accura e be of my 0 1 d . I ve read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed _—_.O,, ,, / Or/
----------------------------
APPROVAL 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 deter nation of compliance with the existing
Cstte plan. Backs flow Device and/or
[ ] This site complies with the site plan as of this date. Current TeSt Data Needed
U011taCt 7"A / 1 -4,11, X 119
Building Official
Date
Zoning Official - c Date
Other Official Date
..................... ----•--•---•---- •--- •--- •-------- •-- •---- - - - -.• ----•----•----------- ---- ------------- -------- - - - - -- - -- - - --
County of Albemarle Department of Community 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 /V 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
Vio ns:
If
If so, st:
Variance:
Y rN1
Ifs ist:
the following:
Intake to complete the following:
Y /0
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y
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
Y / �I
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
P oN
n public water and sewer?
Y ll; �
Will ou be putting up a new sign of any kind? If so, obtain
proper Sign permit.
Permit #
Y /
Wil ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Y / I{�
Is this for sales of Fireworks?
If so, obtain a copy of F/R permit.
Permit #
Prof
Y N
If so, -st:
SP'S'--,,
Y /(N
If so, is t:
10114105 Page 3 of 4
e
Reviewer to complete the following:��--^�"
Square footage of Use: .'Sek—
d
N
iYermitted as: �'�V� A4;u
Under Section: I
Supplementary regl}laltioons sectio'n::+ 1 -�
Parking formula:✓�l��y of 0
Required spaces:
Y/N
Items to be verified in the field:
Inspector Name & Date:
Notes
10114105 Page 4 of 4