HomeMy WebLinkAboutCLE200600196 Legacy Document 2014-10-03W
Application for Zoning
(. oning Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
Clearance 6
C
OFFICE USE ONLY
CLE # -006 -dip
9fn
Check # N N o4 Date:
Receipt 9- N i Staff:
PARCEL INFORMATION
l°
Tax Map and Parcel: > � � �'' � �- �/�1� �' � � Existing Zoning e A
Pass Parcel Owner
con
Cry+ C%1 L'/ & A State 1d" elt - Zip Z
Parcel Address: CSC ®1 de sit City
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project?
6,14611KX d l / i L� City �=f7� �CBt to Zip-C
Address : y
#' _ Fax P ,. !JS E -mail r
Office Phone: T f
PROJECT INFORMATION
Business Name/Type: "
Previous Business on this site:
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 wiOnly 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. on
1 hereby certify that to tl e be t of me knowledge permission have eadtthe conditions eof approval, al, ands I understand them, and that I will abide by them. provided is
true and accurate Y
Printed
/OA/ A L ��
Signature
- -------- ---•-- -• ---
..............
Sp aa0� -5
APpROVAI, INFORMATION [Vj Approved with conditions
[ J Approved as proposed
[ ] Backflow device and/or current test data needed for this site.
[ ] No physico site inspection has been done for this clearance.
site plan. 1V I a`
[ ] This site complies with the site playas of this date. ,
Contact ACSA 977 -4511, x119.
Therefore, it is not a determination of compliance with the existing
Ux lS
Date
Building Official b 2ef l
C Date
Zoning Official /
— Date b Z 0 iG
Other Official
-- .__-------- •--- - - - - -- --- •-- - -• -•• --------- --------- •-- •• - - -• -• - - --
•- •--- ••---- .._..._ Development -- -- -
Count y .
of Albemarle Department of Community
401 McIntire Road Charlottesville,'VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 10/14/05 Page 2 of 4
6;- `..y
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
Violations:
Y/N
If so, List:
Variance:
Y/N
If so, List:
the fo
Intake to complete the following:
Is N'n LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y
W► •1 -t ere 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 ,I N
s parcel on private well and septic?
if so, give applicant a Health Department foirn.
Zoning review can not begin until we receive approval from
Health Dept. FAX DATE T-- 16 — 0 & Q V/
Y /
Is on public water and sewer?
Y / q)
Wilr you be putting up a new sign of any kind? If so, obtain
proper Sign permit.
Permit #
.1 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 #
Y /(
If so,
7 's:
/N
f so, List: s n� Qg d —06, T 0tvVV o f v r�, 2 W G C !✓
10/14/05 Page 3 of 4
Reviewer to complete the following: I
Square footage of Use:
CN i� d�� P
Permitted as:
Under Section:
Supplementary regulations section:
Parking formula: Sp a 0,04
11
Required spaces:
y/N
Items to be verified in the field:
Inspector Name & Date:
Notes
10/14 4 of 4