HomeMy WebLinkAboutCLE200600191 Legacy Document 2014-09-29Applicaticin for Zoning Clearance
OFFICE USE ONLY
CLE #'
,.3 Zoning Clearance = $35 Check # �''�'�.� Date: ` q. _0 tr'
PLEASE REVIEW ALL 3 SHEETS Receipt Staff: _ 5't
PARCEL INFORMATION /y
Existing Zoning_C
Tax Map and Parcel: � D3 —0
.,-
Parcel Owner:
,✓tr1 Cit ��1�e /n frl State ��/ Zip
Parce'i Address: % ZN� �" Y
(include suite or floor)- - - - - -- -------------------------------- ------- - - - - --
PRIMARY CONTACT �'
Who should we call/write concerning this project? ' / ' / b
City Ci/�✓ /a�Teky111 tate ! Zip
��ddress . � E-mail _dT � r ► � /
q✓ C'vX►�
06- q& ? Fax #1� P
office Phone
-
PROJECT INFORMATION 5
Business Name/Type:
Previous Business on this site:
use:
fe-
Circle (if applicable): Fireworks / Christmas Tree Zs 1p y�g> .�� %e
/ ,_/.�
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. e space indicated on
I hereby certify that I own � o v the owner's dge permission to use th
onditions of app o al, d� I understand tl��m,and thattl will abide by themprovided is
true and accurate e Y /��� ,
Printed %
Signature
APPROVAL INFORMATION [ Approved with conditions �k s DN � y
[ ]Approved as proposed N /
[ ] Backflow device and/or current test data needed for this site.
Wo physical site inspection has been done for this clearance.
site plan.
This site com lies with he sit pl as of this date.
Building Official
Contact ACSA 977 -4511, x119.
Therefore, it is not a determination of compliance with the existing
Date
Date Y— -17 _ .�
Date
Other Official
-•• -- - - -- •- .............. - -• ----------- - - --------- --- - - - - - -- - -
.......... ' - _.. County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 10/14/0 Page 2 of 4
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.
Zoning Tech to com
N
D, List:
o — agIp-
the
Intake to complete the following:
Y/N
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
mill re be food preparation? _ 122- ow
If so, give applicant a Health Department form. ►l"-.
Zoning review can not begin until we receive approval from
Health Dept. FAX DATE g" ��
Y/N
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. FAX DATE
Y/N
Is on public water and sewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain
proper Sign permit.
Permit #
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit. .
Permit #
Y/N
Is this for sales of Fireworks?
If so, obtain a copy of F/R permit.
Permit #
Proffers:
®
� Y/N
If so, List:
Variance:
Y/N
If so, List:
SP's:
Y/N
If so, List:
"Ir
PNEV
c...61
10/14/05 Page 3 of 4
Reviewer to complete the following:
Square footage of Use:
P/ N
ermitted as: ?
Y n
✓ �(X
Under Section: t
Supplementary regulations section:
Parking formula: 5.1� �i11I►�'t4�+�-�
Required spaces:
Y / N
e�wt Items to be verified in the field: .' v I L—�-�j
Inspector Name & Date:
Notes
10/14/05 Page 4 of 4
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