HomeMy WebLinkAboutCLE200600195 Legacy Document 2014-10-03Application for Zoning Clearance
Zoning Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
PARCEL INFORMATION
Tax Map and Parcel: 04sX — W J —
OFFICE USE ONLY
CLE# 7 0QU — / �
Check # T I y .l j2 Date: 3 y A —N7 (d
Receipt # --P-1 e� Staff:
c >r
Existing Zonin �r
Parcel Owner:
((��, n j j7 l '�� �,f State p
Parcel Address:=1 a l r"1 t< < y 1 '` I CtTy
ct.
(include suite or oor __ _ _
----- - - - - --
PRIMARY CONTACT
Who should we call/write concerning this prole n ✓ Y / N h I
( l.11 o W City E State _
Address : � "1 �� `�
office Phone:
; 013 JI Cell #_rr``,, I D Fax # ll 7 (
E -mail
PROJECT INFORMATION
Business Name/Type:
Previous Business on this site JA
Ir i
Proposed use: - .C)/ lkl IA111';
Zip
Circle (if applicable): Fireworks / Christmas Tree
CF.F 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.
Clearan ce will be required.
id d is
owner's permission to use the space indicated on this application. I also certify that the information prove
1wle e. I have read the conditions of approvaiUt and I understand them, and that I will abide by them.
)--- Printed `—''"' ' "" m,
If you change, intensify or move the use to a new location, a new Zoning
I hereby cert)6 tha I own or
true and ag ura5k)to the best
Jtgiia� is _ r*s
--------------------
R AL INFORMATION [ ] Approved with conditions
] Approved as proposed
[ ] Backfl ow 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. Bacpgr Device and or
nt Tes a
CSA 977 + a 9
Date � I °�•-� `� �
Building Official _
Date
Zoning Official
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
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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.
r
[ntake to complete the following:
Y /O[s use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/N
Will4 eere 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 /r)Is pars I 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
V N V
n public wa er and sewer?
Y /
Wil u be putting up a new sign of any kind? If so, obtain
proper Sign permit.
Permit #
Y
Wl tie be any new construction or renovations?
If so, obtain the proper Permit.
Per i)oor Y/N
Is this- sales of Fireworks?
If so, obtain a copy of FIR permit.
Permit #
Zoning Tech to complete the following: Prof
Viol o s: Y /
Y / If so, List:
Ifs
Vto p'S
's:
Vari.4�je: `� � ��✓�..
Y /11�/I If so, List: o '
If so,ist:
r
A 1 1 P M d
Mj
10/14/05 Page 3 of 4
Reviewer to complete the following:
Square footage of Use:
N L C7ii� ��CC�
ermitted as: �v" ` Q
Under Section:
a� -:a,t C25
Supplementary regulations section:
Parking formula: A
t
Required spaces:
GJlil Q h �t�ti..
y/N
Items to be verified in the field:
Inspector Name & Date:
Notes
1(,
. D{ V,-4,� g 19 1 0 Cv
G�
10/14/05 Page 4 of 4 J/