HomeMy WebLinkAboutCLE200600192 Legacy Document 2014-09-29Application for Zoning
Clearance
OFFICE USE ONLY r^
❑ Zoning Clearance = $35 CLE # /
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PLEASE REVIEW ALL 3 SHEETS Check # I/ Date: � Receipt # in L-3 51 Staff:
PARCEL INFORMATION
Tax A4ap and Parcel:
Existing Zoning 0 a °" , l r-"
�' �� �I City �� � State
Parcel Address:
include suite or floor --- - - - - --
PRIMARY CONTACT
Who should we call/w! jrite con" cerning this project?
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city
`4 Y% State
zip �' %
zip 7i 0%
Address :
( -7 bra % Z Cell # �J3" �° ° Faz %�0� 77�'vla E -mail �s'% kardl ►61' - �'►?c�ae -9. G%� -
Office Phone: "3 1 ! >
------------ - - -• -- \
PROJECT INFORMATION B�
Business Name/Type:��', "��17
Previous Business on this site:
use:
-
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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 owne?s permission to use the space indicated on this application. I also certify that the information provided is
true and accurate e est of my kn wledge. I have read the conditions of approval, and I understand them, that I will abide by them.
Printed i Q r ` th
Signature \/ -------------------------------- _
APPROVAL INFORMATION Approved with conditions
[ ] Approved as proposed
[ ] Backflow device and/or current test data needed for this site.
[ ] No physical site inspection has been done for this clearance.
site plan.
This si te coin lies with the site plan as of this date.
Building Official
Zoning
Contact ACSA 977 -4511, x119.
Therefore, it is not a determination of compliance with the existing
Date 'F. t `�> `0 rQ.'
Date _ 2VI, O �
Date
Other Official
.........................
- •---- •• - -•... - County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 10/14/05 Page 2 of 4
&__ 6
Applicant to complete the following:
YIN
Do you have one of the following?
Tax Map and Parcel Number and or;
Address of use (include unit or floor if appropriate;
YIN
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 com
W
,AO
Variance:
YIN
If so, List:
the following:
Y ® V IW
.ntake to complete the following:
(IN
s s use in LI, HI or PDIP zoning. If so, g ive applicant a Certified
Engineer's Report (CER) packet.
YIN
Will there be food preparation?
If so, give applicant a Health Depart ment form.
Zoning review can not begin until we receive approval from
Health Dept. FAX DATE
YIN
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
YIN
Is on public water and sewer?
YIN
Will you be putting up a new sign of any kind? If so, obtain
proper Sign permit.
Permit #
YIN
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
YIN
Is this for sales of Fireworks?
If so, obtain a copy of FIR permit.
Permit #
Proffers:
YIN
If so, List:
SP's:
YIN
If so, List:
10/14/05 Page 3 of 4
:1
Rev ewer to complete the followings
Square for),tage'of Use:
Permitted as: In 01CA
Under Section:
Supplementary regulations section:
Parking formula: r^—�
Required spaces:
Inspector Name & Date:
Notes
10/14/05 Page 4 of 4