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HomeMy WebLinkAboutCLE200600179 Legacy Document 2014-08-20%r Zonin Clearance Application g „n:I` OFFICE USE OT LY F] Zoning Clearance = $35 CLE # Check St Staff: 1Y4C�""" PLEASE REVIEW ALL 3 SHEETS Receipt # PARCEL INFORMATION R .n `H Existing Zoning Tax Map and Parcel: � It Parcel Owner: �J ' ,� Q --p^ VZ3 r,3 State �!h i N 119 I Zip Z Parcel Address: g�L'� � ocvrisq 1 P �- City (include suite or floor)- - - - - -- ----•------------- - - - - -- PRIMARY CONTACT i S C - Who should we call/write concerning this project? �� *� 1'�� 22-P 4.3 C 3 `.;1 1 CityG(z9�laaoQ State Vle-6iQ1iii zip Address : +_ V E -mail SY 1Gilal�C.� SOD � GGvvl L���i_(c(I� -_Ce1� #417 % +J717 Fax #_ Office Phone: ----------------•---- -F�O• ----------------------------------- g();,rEC'T INFORMATION O�S 6" C-two �— Business Name/Typ e : Previous Business on this site: Proposed use:r%� Circle (if applicable): Fireworks / Christmas Tree SEE CONDITIONS OF APPROVAL IF'I'HE 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 ovwndei'e permission e eadtthe�condit conditions appro al, d I understand them, and that I will abide by them. provided is true and accurat o the best of my g I � ���� f��r•IL` ---- Printed 't` Signature ------------------ �- APPR VAL FORMATION J [ ] Approved as proposed Approved with conditions ` D [ ] Backflow device and/or current test data needed for this site. Contact ACSA 977-4n 1, x119. NA 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 Zoning C Date Date Date Other Official -----._...__------ County of Albemarle Department of Community Development 401 McIntire Road Ch to esville, 2 4126 10/14/05 Page 2 of 4 VA 229X Voice: (434) 296 -5832 Fax: (434) 97 wplicant W Complete the following: /N )o you have one of the following? rax Map and Parcel Number and or; appropriate; Address of use (include unit or floor if app ro p Y / N that Do you have a Floor Plan (sketch lease provide it with the drawing) includes the following, and if so please 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 cture, note the location within the If using less than the entire stru structure. -3- b(P d O LIOX � f Tech to complete the Viol )ns: YI If : Var* ee: Y /(N / If so, ►st: Intake to complete the following: Y g applicant a Certified Is u n LI, HI or PDIP zonin ? If so, give app j Engineer's Report (CER) packet. � y� aJt*l I Y 4� 9� F -®%% ees�' aration? i 2� W i1 re be d prep If so, give applicant a Health Departmen t form Zoning review can not begin until we receive appro 1 from Health Dept. FAX DATE �' Cam_ Pro � • dc� ' Y n We on private well and septic. s P a If so, give applicant a Health Department form. Zoning review can not begin until we receive approval from i E gio- 3, 0 Health Dept. FAX DAT ,,�nn nn ,^,,�{ F Q/ 0 ` C Y Is on lic water and se er? Y N ki% d� �so, obTaln W i ou be putting up a n si n of any proper Sign permit. 72— Permit # Y N) Wil there be any new construction or renovations? If so, obtain the proper Permit. Permit # Y f Is th' or sales of Fireworks? of F/R permit. If so, obtain a copy Permit # Pr MtY If s, SP's: Y If s Dl: 10/14/05 Page 3 of 4 Reviewer to comple,ae the %011 wing: Square footage of OF ©!" Y / N coo -tDU'G C� (t l !�l I�°Ia) D . Z.. 2— ermitted as: � -Fa _— Under Section: , Vn, rb � l Supplementary regulations section: ` Parking formula: i' ( b �� Required spaces: _ MM'N s to be verified in the field: Inspector Name & Date: Notes 10/14/05 Page 4 of 4