HomeMy WebLinkAboutCLE200600176 Legacy Document 2014-08-20• r
Application for Zoning Clearance
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PLEASE IZVVMW ALL 3 SHEETS Cheek #!-4c1"7 Date:' 904
Receipt 0 -(i+ � � � o Staff:
PARCEL, INFORMATION fl
Tax bill and Parcel: J� ��.,�� k- �—� "Sting Zoning PD—
Parcel
ne :.sue ,, fvs C+-p
r�cl.Address:� iSrt -�10 �? -- city 6 state ra" Zip�_1
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#� CONTACT
.Who should we calllwrite concerning this pro3ect"t S D n 6001
Address :%n Lq& Cl a V ty el ason, .. sfateygj ziv3SGt -(4
a ffice'Phoue: ,(9A662q
---------------------------------------- .......... - - - --
P ter T I>vFOR .T IO?i
Ousiness.Nameffype: rr d �S r�
Previous Business on this site.- )_U (Y & V-U
Proposedf use• f - +CL I l i�Yl 4 .
Circle (if applicab1c): Fireworks' 1 Christens Tree
SEE CONDITIONS OF APPROVAL IF THE CLEARANCE IS FOR FIREWORK OR CHRISTMAS TREE SALES (Sheet 1)
*This Clearance will only bo volid on the parcel for winch it is approvcs L If Yom dwnge, iateeysify ar move the use to a new location, a View Zoning
Cleamee will be required.
I hereby cCrtify that I own or have the owner's pcmission to vse the space indicated on this application. I also acetify that the infomadon provided is
true need acourste the best of my knowledge. ave road the aanditim4 ofapproval, and I understand them. and that I will abide by them.
Signature s�� Printed �!JSG%/� � �TJ. PJ ✓�7�
----------- -- ------ --------- - -------------------------------- --1._..,.11- --------------------------------------------------------------- - - - -�-
XPROVAL INFORMATION
Approved with
Apprcded as proposed -
j • with conditions
j $aaktlow dovice audlor current test data heeded for this site, Contact ACSA 977 -4511, x119.
No 'physical site inspection has been done for this clearance. Thcxcfbre, it is not a deter �ati¢n f cum liance with the existing
site plan. Backflow Device and /or
13 This situ complies with the site plan as of this date. Caarrvxt Test Data Needed
1, x 119
Building Official �-
Zoning Official IA-- tied Dot
Other Official ate
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Coun of Albemarle a rtmen i of Commta ,i �eveloptment
401 Mcbtiire Road Charloitesviile,'VA 2290;Zoice: (j64) 296 -5832 Fax: (434) 972. 4126 10114/05 Page 2 of4
I
Applicant to complete the following:
YIN
Do you have one of the following?
Tax MV anti Parcel Number and or,
AddTM of use (include unit or :Floor if appropriate;
IN
o you have a Fluor plan (sketch or an arcliitect4 drawing) that
imludca the following, Md 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 rooms or area
ifusing less than the entire stracture, note #te location within the
sirucilrre.
.Tech to complete the
.Ih\1 (65
Y / N
If so, List,
Intake to complete the following:
y f
us " LI, HI or PDIP zoning'- If so, give applicant a Certified
Engineer's Report (CER) packet_
Y /0
Will thore be food prcpmration?
If so, give applicant a Health ?department form.
Zoning review cart not begin until we receive approval from
Health Dept- FAX DATE
Y l ie), Is on psivate well and septic?
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from
I -ealth Dept. FAX DATE
// N
on public water and seweO
19/ N
ill you be putting up a now sign of any kind? If so, obtain
proper :sign permit.
Permit #
-
Will ere be any now constmadgn or renovations?
If so, obtain the proper Permit.
Perma #
Y 16)
Is this for sales of Firewrorks?
If so, obtain a copy of Fa permit.
PeY-mit #
Proffers:
YIN
If so, List:
$P's:
YIN
If so, List:
1 ()/14 10S Fagg 3 of