HomeMy WebLinkAboutCLE200600204 Legacy Document 2014-10-03Application for
Zoning Clearance
oning Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
0
Tax map and parcel: 0 (P 1 1_nQ - 00 - 06 C-) V �e� �isting Zoning: _ 00 `m M
Parcel Owner: Pre ty) i e i2 L(-C- Q/ 0 Asvts�_ %— 1-L- C
Parcel Address: qqO Pr&lnTe_R CL!+ S"kaiwe3c City c1h y'% / % 1P_ State V0, Zip 'L t idj
(include suite or floor)
Contact Person (Who should we call /write concerning this project ?): .5a/4 h 7 � 14 vISCAI\
Address 'I LY 6 prc:r ' 1&-y- City �kO'''l� f� °�State t/ ,�q Zip Zzceo
!�2 2
Daytime Phone Gb3 ZZ�('-G703 Fax # L) ��E-rnnil- UJAW • d&(4 b k0 —M414- C 11lgIMC -
Business Name/Type: �G� �L,S�C•nf tom- fry ✓ /t,n�tc.,� --i Z_ Le-C
Previous Business on this site:
SEE CONDITIONS OF APPROVAL IF THE CLEARANCE IS FOR FIREWORK OR CHRISTMAS TREE SALES (Sheet 1)
Circle (if applicable): Fireworks / Christmas Tree
*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 owner's permission to use the space indicated on this application. J also certify that the information
provided is true and accurate to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will
abide by them.
2Z- Z00
'gnature of Bu s Owner or —Agent ( Date .
�"�. V t cr.� � ► vin w�enn9�_'�' '
Print Name
AP,DROVAL INFORMATION
['`,}'Approved as proposed [ ] Approved with conditions
[kflow 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.
Building Official Date
Zoning Official Date
Other Official Date
FOR OFFICE USE ONLY CLE # 2-U0 4� °° 20q
Fee Amount $ 3S .'L'' Date Paid 19- 27-04:p By who? ,,)eA,yi (k S t M rA O r-yJS Receipt # 61100,5 k# By:
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 511106 Page 2 of
t -'
Applicant to complete the following:
Do you have one of the following?
❑ YES ❑ NO
Tax Map and Parcel Number and or;
Address of use (include unit or floor if appropriate)
❑ YES ❑ NO
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 complete the
Violations:
[/YES ❑ NO
If so, List�I O ( t)
Var' nce:
YES ❑ NO
If so, Lis
V : 1 -b�8
Intake to complete the following:
❑ YES O
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
❑ YES [] NO
Will there 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
❑ YES NO
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
Z�t ept. FAX DATE
ES ❑ NO
Is on public water and sewer.
❑ YES ❑ NO
Will you be putting up a new sign of any kind? If so, obtain
proper Sign permit.
Permit #
❑ YES Ej NO
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
❑ YES 2NO
Is this for sales of Fireworks?
If so, obtain a copy of F/R permit.
Permit #
Proffers:
❑ YES 2r NO
If so, List:
SP's:
❑ YES []'NO
If so, List:
511106 Page 3 of 4
Revie er to complete the following: r�
Squ e footage of Use:
YES ❑ NO VA @�.0 f GC.
Permitted as: f �G$i.l 0
Under Section: *.a. t
Supplementary regulations section:
Parking formula: o� O O �, �d • ��
Required spaces: atQ
❑ YES aNO
Items to be verified in the field:
Inspector Name & Date:
Notes
5/1/06 Page 4 of