HomeMy WebLinkAboutCLE200600183 Legacy Document 2014-08-20'may\
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Applicati n for Zoning Clearance
��RGIN
OFFICE USE ON Y
E] Zoning Clearance = $35 CLE # o
PLEASE REVIEW ALL 3 SHEETS Check # Date:
Receipt # Staff:"'
PARCEL INFORMATION
Tax Map and Parcel: ��� W 6 '"_ Q aT QQ Existing Zoning
Parcel Owner:
Parcel Address: 1 jq p,,�`
L-Ijx ty �l/ (�G State VA. Zip�� z4
(include suite or floor)
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APPLICANT INFORMATION
Who should we call /write conccerppn��in/g� this project? � v( / �� j /� f
Address: � t/ "� !`�k � ` /rCity c V State V4 Zip lq t
Office Phone:" l Cell #q el 3 - -Fax # E -mail M (g441- e((9 Z!Ctt'l a17 6Cu0l
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PRIMARY CONTACT L_blV yA ` 5 C 6VVS W 6k � z 6L A-5p 62 U L
Business Name /Type:
Previous Business on this site:
Proposed use: L 0
Circle (if applicable):
Fireworks / Christmas Tree
L(qkh '
f, .
SEE CONDITIONS OF APPROVAL 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 kilowledgge. I /have read thScQnd ix ons of approval, and I understandd them, and that I�will abide bby them.
Signature
Printed��I"
g
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APPROVAL IN-- F0-- RMATION
[�Q] Approved as proposed [ ] Approved with conditions
No physical site inspection has been done for this clearance. Therefore, it is not a determination of c m ��L�411'PtI� Eigmd /or
C " urrent Test Data Needed
site plan.
[ ] This site complies with the site plan as of this date. Contact ACSA 977 -4511, x 119
Building Official
Zoning Official
Date
i
:w Date �D.h
1,
Other Official Date
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County of Albemarle Department o c mun Development
i /' 1 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Applicant to complete the following:
QNN
have one of the following?
Tax Map and Parcel Number and or;
Address of use (include unit or floor if appropriate;
Y/N --
o 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.
, oning Tech to
Viol ons:
Y /
the
Variance:
YIN
If so, List:
9/28/05 Page 2 of 4
Intake to complete the following:
Y /CN
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /tK
Will ere 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 p&df 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
N
on public water and sewer?
Y/N
ill you be putting up a new sign of any kind? If so, obtain
proper Sign ermit. "
Permit
.J / N
Will there be any new construction or renovations?
If so, obtain the proper Permit,{. � �
Permit # �% C�/f
Y /�N -~tj i. � D b bl d o
Is tli for sales of Fireworks?
If so, obtain a copy of FIR permit:*
Permit #�
Proffers:
YIN
If so, List:
SP's:
YIN
If so, List:
9/28/05 Page 3 of 4
s Reviewer to complete the following:
Square footage of Use:
/N �i
Permitted as:
Under Section: 2 0�
Supplementary regulations section: 1/11X_
Parking formula: A���
Required spaces: s- --
Y/N
Items to be verified in the field:
Inspector Name & Date:
Notes
3/28/05 Paee 4 of 4