HomeMy WebLinkAboutCLE200600189 Legacy Document 2014-09-29Application for Zoning Clearance
OFFICE USE Oi LY T —�� f
O Zoning Clearance = $35 CLE #
Check # �. Date: '
PLEASE REVIEW ALL 3 SHEETS Receipt # Staff:
PARCEL INFORMATION
Pk e-
Tax Map and Parcel: fJ i �J �f co Existing Zonin /i'k -u
� 1° Ni Ci � i..�l
Parcel Owner: 1- A
C? State V— p/
�°g Zi
°'+-1 C 4 e 0'1'1 Y jv o l e L N City Ll v �
Parcel Address: s ! -------------------------------------------
mclude suite or floor)
-------- - - - - --
PRIMARY CONTACT
Who should we call/write concerning this project? r a
City ��Itax��= -e-- State VA Zip n llo
Address : 13 L7 �� ` ��
Office Phone: �j C223 y `
Cell 5-• Fax# E-mail t3 ���- /3- �Q-�f'
PROJECT INFORX,AXION ., - ;) --
Business Name/Type:
Previous Business on this site:
Proposed user "cam L
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 t o knowledge. I have readtthe conditions of approval, and I understand them, and that I will abide by them provided is
true and accurate to the b Y
�i.� ��b,�2--_ Printed �6itti �c�
Signature
----------------
APPROVAL INFORMATION [ ] Approved with conditions
[ ] Approved as proposed
[ ] 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.
Date
Building Official _
Date
Zoning Official j
Date d
Other Official
--•---••------
_..._..._.... -...- ---- •--- -•• - -• - -• - -• - -- ----------------------------------- - - -- --
- - County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 10/14/05 Page 2 of 4
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1•
Applicant to complete the following:
)/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.yQ
Zoning Tech to complete the
Y/
If s4
Var ce:
Y/N
If so, ist:
Intake to complete the following:
Y
ied
Is u I, HI or PDIP zonin g? If so, g ive a pp licant a Certif
En
Report (CER) packet.
�/ N
Will there be food preparation?
If so, give applicant a Health Department form.
Zoning review can not begin until a receive approval from
Health Dept. FAX DATE Ct,
Y/0
Is parcel 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. FA/X DATE
&/ N
Is on public water Ansewer?
r / N
Will you be putting up a new sign of any kind?
proper Sign permit.
Permit #
1, ,4V� UFO ed.
MIAL=
oiOoo— 1.54-
If so, obtain
S/N
Will there be any new construction or renovations? CX4e-ri O-r
If so, obtain the proper Permit w-
Permit# ��b� 8 crl�`tti Co-oQ.(ti-
�v I` .
Y /�A
Is this for sales of Fireworks?
If so, obtain a copy of F/R permit.
Permit #
Proffe s:
Y /
If so, )St:
SP1s•
If so; List:
10/14/05 Page 3 of 4
h eve v r,to complete the following: Z�
SOare footage of Use:
N ---
Permitted as:
Under Section: d�
Supplementary regulations section: D�
Parking formula: J ) D 6 0 6-CA
Required spaces: 9 t
Inspector Name & Date:
Notes
10/14/05 Page 4 of 4