HomeMy WebLinkAboutCLE200600184 Legacy Document 2014-08-20Application for
Zoning Clearance
❑ Zoning Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
Tax map and parcel: M P to I j
' —
Parcel Owner: 6Ltcz � k%-7 i� / w `
Existing Zoning:
/r
Parcel Address: WooD S ). �--✓V �+ City ( D7_6S ViUCState V14 ZiAQ 0
(include suite or floor) JCJL
Contact Person (Who should we call/write concerning this project ?):
Address 97-7 ttS�j,' &41//0 0 LC``-��`1� A IL 133 740 City ��A eLOTE�' ( /ALL State V 4 Zip 6200
Daytime Phone (13�) Ol O ° 9 '?S_ Fax # ( j v < -� �Q� E -mail
BusinessName/Type: AIEW NE-'11 0Y9R-Ti)C-)zS, C-t,C 1NgAj,4 - c,MENT
Previous Business on this site: NONE IN 77fts -9UW7Z
Proposed use: 01=FICC
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 ow per's permission to use the space indicated on this application. I also certify that the information
provided is true and accurate to the best f mledge. I have read the conditions of approval, and I understand them, and that I will
abide by them. _ ygw
of Business Own r o Agent Date
-TZL ALT�N— U_AJ7-
Print Name
Backflow Device and/or
MtH
PROVAL INFORMATION Contact AC,SA 977 -4511 e
Approved as proposed [ ] Approved with conditions ► x 119
[5A "ackflow 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.
Building Official Date & (o (_
Zoning Official Date _'
Other Official Date L.
. 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
FOR OFFICE ] , ONLY
C
#
-7
Fee Amount $ Date Paid
By who?
Receip '{ Ck # By:
. 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?
YES F-1 NO
ax Map and Parcel Number and or;
Address of use (include unit or floor if appropriate)
YES ❑ NO
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.
coning Tech to complete the
Violations:lq
❑ YES NO
If so, List: /
Variance:
❑ YES NO
If so, List:
Intake to complete the following:
❑ YES "NO
Is use in LI,R or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
❑ YES VNO
Will there 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
�rarcelSoif �IOprivate 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
I �XYES ❑ NO
s on public water and sewer?
❑ YES 2 NO
Will you be putting up a new sign of any kind? If so, obtain
proper Sign permit.
Permit #
❑ YES NO
Will there e any new construction or renovations?
If so, obtain the proper Permit.
Permit #
❑ YES NO
Is this fors /es f Fireworks?
If so, obtain a copy of F/R permit.
Permit #
YES ■ NO
• • U !i l
jw
... �rnm��ir
Pi SP, .11
IYES ■ NO
If • .
• ka
OR
511106 Page 3 of
Reviewer to complete the ll hymn ,, . ( :� Ajk,&,d 'D
Square footage of Use: 1S tf
OYES ❑ NO
Permitted as: 41-CIC
Under Section: �U A
Supplementary regulations section:
Parking formula:
V
Required spaces: od &4' x
❑ YES ❑ NO
Items to be verified in the field:
ti►, ,
Inspector Name & Date:
Notes
- C�� o o d
5/1/06 Page 4 of 4