HomeMy WebLinkAboutCLE200600171 Legacy Document 2014-08-20Application for Zoning Clearance
Zoning Clearance = $35
PLEASE REVIEW ALL 4 SHEETS
OFFICE USE ONLY / '%
CLE # zop r(? ' 1 / 1
Check # Date: i — —060
Receipt # Staff:
PARCEL INFORMATION Chi
Tax Map and Parcel: (7 5W —00— — 03 Existing Zoning
Parcel Owner: Cywr,5t— \Ae ' G4Yyk S , C1r1 p
Parcel Address: AV Y4 � Scm a,--y X3910 City S, �c3�A Sr�1 i� ESL State VA- Zip 2'Z5:71
(include suite or floor)
APPLICANT INFORMATION ' \
Who should we call /write concerning this project? �D ► da �t�5�
Address: (o3b gd' 7464�twn P" y ':L".5 (Y0 City CV i I LQ- State U A Zip Z Z51)
Office Phone: (` 3_% 9YZ ^7 _1YQ Cell # Fax # 1Y7--754_Z_ E -mail
PROJECT INFORMATION
Business Name /Type: �rbd�
Previous Business on this site:
Proposed user YY14--a;Cea.) pr'e_4 L,�ef w,e %S k
-, V, -
Circle (if applicable): Forks / C as Tree
SEE CONDITIONS O APF PROVAL 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 to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature_ Printed
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AP OVAL INFORMATION
( VjApproved as proposed
Building Official
Zoning Official
Device and /or Approved with conditions FBackfjow
urrent Test Data Needed
r - A 077 -4511. x 114
Date � --
Date Q JD4�
Other Official Date
-------------------- - - - - -! -- �' - - -�
- - - -- ---- - - - - -- --.--------------------------------------
County of Albem -le Depart nt of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
3/28/05 Page 2 of 4
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Applicant to complete the following:
Y>N
Do you have one of the following?
Tax Ma and Parcel Number and or;
ddress of a (include unit or floor if appropriate;
�! N
Do you hav (a Floor sketch or an architectural drawing) that
includes the following, and if so please provide it with the
application?
Th otal s uar f 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.
7S7'
! oning Tech to complete the following:
Vio �o s:
Y
If L' N
Hance:
Y N
I so, List:
vr6r 400
Intake to complete the following:
Y/N ,
Is u LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y kN
Will Ike 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
Is / 1
Is pa 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
'Y)/ N
on public water and sewer?
Y
Will be putting up a new sign of any kind? If so, obtain
proper Sign permit.
Permit #
Y N
Wi t re be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Is
Is this r sales of Fir'eworks7 „
If so, obtain a copy of F/R permit.
Permit #
/N
so� List:
S�'s:
�(Y J/ N
so, List:
n
3/28/05 Page 3 of 4
Reviewer to complete the following:
Square footage of Use: Q
[`YES ❑ NO
Permitted as: �% 1�%�� 7 i d 14WI O C g, — ✓ 4 C(d a)
Under Section: A % • ���) Aa • 9.1b CI)
Supplementary regulations section: 11A—
Parking formula: 1120 O Pt e�f
Required spaces:
❑ YES ❑ NO
Items to be verified in the field:
Inspector Name & Date:
Notes
511106 Page 4 of 4