HomeMy WebLinkAboutCLE200600186 Legacy Document 2014-09-29L,,� +0 G f pm
Nppfkation
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oning Clearance = $35 /
PLEASE REVIEW ALL 3 SHE,
PARCEL INFORMATION
[#CE USE ONLY
k # A Date:
pt # Staff:
Tax Map and Parcel: d (D) 0(7 - 00 Existing
AVIR
IN
Parcel Owner: S h o l2j2 N rA 042, 2, CL SSO e 0-1 O Si m C-11 Ae bC r -+0 / / 0
Parcel Address: [ b 0 Po City State Zip
(include suite or floor)
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APPLIC- ANT INFORMATION
Who should we call /write concerning this project? yy-\. 41& gL ("�� X) \
Address : ~ City State _ (A Zip �� 1
Office Phone: (� Ce x # 33_c 51466 E -mail er M A- (
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PRIMARY CONTACT
Business Name /Type: 6 a ";`a
Previous Business on this site: �'� (� '(1 C1T�� (' _
Proposed use•
Circle (if applicable): Fireworks / Christmas Tree
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 I the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by t��,h///eem..
Signature Prlrited am. a\:�1A\s
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AROVAL INFORMATION
[ Approved as proposed [ ] Approved with conditions
PJ CkCi4 -.4vtlu
[ v1 ' o physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
site plan.
r 1 This site comnlies with the site nlan as of this date.
Building Official Date S 0 C.
Zoning Official Date 110
Other ffici 1 Date
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County of Albemarle De rtm'�nt of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Applicant to complete the following:
Y/N -
Do you have one of the following?
Tax Map and Parcel Number and or;
Address of use (include unit or floor if appropriate;
Y/N
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.
Tech to complete the
Vio ions:
Y N
If s , t:
Vari Vi e:
Y /
If so, t:
Intake to complete the following:
Y6N�,
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
9/28/05 Page 2 of 4
If so, give applicant a Certified
�illdb&e 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
Y
Is p cel 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
public water and sewer?
Y /(
Wil ou be putting up a new sign of any kind? If so, obtain
proper Sign permit.
Permit #
Y /
Whtlf
il ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Y
Is this or s N
ales of Fireworks?
If so, obtain a copy of F/R permit.
Permit #
I Pro{f� /fPis s:
If sty, t:
SP's:
Y /
If so, ist:
Reviewer to complete the following: �.Z n (�{
-'Square footage of Use: /
N/ N -r' n y
rmitted as:
Under Section:
Supplementary regulations section:
Parking formula:
Requir d spaces:
Y N
Ite o be verified in the field:
Inspector Name & Date:
Notes
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