HomeMy WebLinkAboutCLE200600169 Legacy Document 2014-08-20Application for
Zoning Clearance
lia/zoning Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
aCL*
171,2,q
Tax map and parcel: ! 7? ' { `) IF �} Existing Zoning: f C
Parcel Owner: TCA Y1�_/r 1 $ 3 ] - GC(�G(� � (Z l ���j f_,1� -1.1C 1-1 S, MIA ��U-+ 1
Parcel Address: �� s�TV'1a -j � ,�L1(K� city �_j'Ya_F-I,b-H<7(}1 l State Zip I 1
(include suite or floor) r
Contact Person (Who should we call/write concerning this project ?): 1,..
'Address lets mill q1�� /2�lC3it T)Rfy— �yy City �� i�1lL SUCIt� state _Zip � iI
Daytime Phone G'� 1- U I Fax #( ir���.C'- -C6 1() E- mail \i( -CSMe l-IUtn Ac(-, COM
Business Name/Type: 1=- } e,SA �~ay/l p�T_i�n ,I
Previous Business on this site: l /IlavLo \ i�SL�1� 1�_ _'Pk n �1CeM�` C h ( Sicn6be c �--a-P1dle- J
Proposed 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
abi by them. 'I
Slgnat a of Business Owner or Agent Date
s A+-r lv A-• P��� 1�1
Print Name
Backtlow Device and/or
AP,PROVAL INFORMATION Current Test Data Needed
[ Approved as proposed [ ] Approved with conditions Contact ACSA 9774511, x 119
[ ] Backflow device and /or current test data needed for this site. Contact ACSA 977 -4511, x] 19.
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 Date L
Zoning Official Date a F b
Other Official . Date
,k _ a Z4 -
FOR OFFICE USE ONLY CLE #
Fee Amount $ 3,9-q100 Date Paid (n—?T-01CBy who? C t_/t_ Rec pt # (07S-7 0 Ck# q70<0 <0 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 of4
X
Applicant to complete the following:
Do you have one of the following?
2AYES ❑ NO
Tax Map and Parcel Number and or;
Address of use (include unit or floor if appropriate)
[YES ❑ 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 the
structure.
,oninLy Tech to c
Violations:
❑ YES NO
If so, List: Y1.1
.r
Variance:
❑ YES NO
If so, List:
the
Intake to complete the following:
❑ YES �9/NO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
❑ YES E 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 R'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
NKYES ❑ NO
Is on public water and sewer?
❑ YES Z'NO
Will you be putting up a new sign of any kind? If so, obtain
proper Sign pen-nit.
Permit #
M E
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
❑. YES NO
Is this for sales of Fireworks?
If so, obtain a copy of F/R permit.
Permit #
Proffers:
❑ YES V1<O
If so, List:
SP's:
❑ YES gj-N
If so, List:
511106 Page 3 of 4
Reviewer to complete the following:
Square footage of Use:
&?"YES ❑ NO
Permitted as:
Under Section:
Supplementary regulations section: -�
^^77 D
Parking formula: 2-0 D
Required spaces:
❑ YES ❑ NO
Items to be verified in the field:
Inspector Name & Date:
Notes
511106 Page of
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