HomeMy WebLinkAboutCLE200600178 Legacy Document 2014-08-20Application for
Zoning Clearance
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Zoning Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
Tax map and parcel: 'ld / 6 60 —60—
Parcel Owner:
Existing
Parcel Address :_ 50 �e City t- Lt) A-25117/'State, /7'state Vp a; op
(include suite or floor) I _
� c
Contact Person (Who should we call/write concerning this project ?): / C
Address �.I( LU nL� bVtrG City r AStl, /7� State Zip
Daytime Phone �� _ (a Fax # /Q—� l %� E-mail 7%7 r/ LJ �, l��Q_� �1� U
Business Name/Type:
Previous Business on this site:
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
abide by them.
-7)17 F �z
Signat6re7R Buiii4efiT yvnel; or Agent A Date
Print Name
APPROVAL INFORMATION
[ ] Approved as proposed [VfApproved with conditions
10 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.
[.-]`This site complies with the site plan as of this date.
Zoning Official
Other Official
FOR OFF1C_F USE ONLY ff C, jy CL _ / , y�,� !�
Fee Amount $ 'b S • «% Date Paid Zl � (� L y who? Receipt # & �I.�. 0 c k 9 By: /1/0-7�—
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
Applicant to complete the following:
Do you have one of the following?
�S ❑ NO
Tax Map and Parcel Number and or;
Address of se (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.
to
Violations:
❑ YES NO
�\
Ifpsoa,L�St:
11p s �
Variance:
❑ YES J21NO
If so, List:
"Igo -6p tno'Sew
Intake to complete the following:
❑ YES �TO
is use in L or PDIP zoning? If so, give applicant a Certified
Engineer'sReport (CER)packet. j:�6as at) r-C��/
YES NO -"� .Co6a
there a food preparation. W 44
I AA-0
If so, give applicant a Health Department form.
Zoning review can not begin until w receive approval from
Health Dept. FAX DATE .. — 6 G rl - z r S
b 1
❑ YES [� NO
Is parcel on vate 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
YES ❑ NO
s on public water and sewer?
❑ YES ❑ NO
Will you be putting up a new sign of any kind?
proper Sign permit.
Permit #
If so, obtain
YES ❑ NO
Vft there be any new construction or renovations?
If so, obtain the Foper Permit.
Permit # A a io - 2
g�1�Io
❑ YES ❑ NO cQ &ArWM,) W nk-
Is this for sales of Fireworks?
If so, obtain a copy of F/R permit.
Permit #
Proffers:
❑ YES E31NO
If so, J ist:
YES ❑ NO
or
1 4,
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511106 Page 3 of 4
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Reviewer to complete the following: DI n I 0& —
Square footage of Use:
ES 0 gc " -P+
C �i
ermitted as: S ilJb c{
Under Section: ...2 j� �
Supplementary regulations section:
Parking formula:
Required spaces:
YES 0 NO
Items to be verified in the field: _ Sp w l Gilt 7�1?'YUCt
Inspector Name & Date:
Notes
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511106 Page 4 of 4