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HomeMy WebLinkAboutCLE200600224 Legacy Document 2014-10-03Application for Zoning Clearance [ ning Clearance = $35 PLEASE REVIEW ALL 3 SHEETS Tax map and parcel: (� �i ©d ©® ° d O i '(� D Existing Zoning: i_ °T Parcel -' i e X11 A• /�� I �RCIN�P °Z ZI F� X �'i P i�! 'Tl-y CJh, v� � .0 1� Zip2 9101 Parcel Address: State (include suite or floor) Contact Person (Who should we call /write concerning this project ?): Address roy. .( City CJ�tU'-`oCl���%t�rl�'— State Zip 7---7-101 o��srs7 zZ vbs Daytime Phone Cfjf) -;21's - T_'f_0) Fax # lr( 1L Zc1 *3" & 1 &, q E -mail Business Name /Type: 1c cA&_.S-e_ J l,z,— ,,!C Previous Business on this site: Proposed use: —2-4—o 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. I 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. Signatur of Business Owner r Agent Date Print Name APPROVAL INFORMATION [ ] Approved as proposed [ VApproved with conditions [- ] Backflow device and /or current test data needed for this site. Contact ACSA 977 -4511, x119. [Vf No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing site plan. [ ] Tt s site complies with rye site plan p� of r, i date. 2 � d � � / � _ n / n 1/�ll Ud.- #—n,Ptv�t,;�I'(.(�l l�tl ,-f1A "7iT' � ,,C1,(�C• AiirXi(p X Building Official Date (S o Zoning Official Date Other Official Date FOR OFFICE USE ONLY CLE # Z ©O " � Fee Amount $ 35,0 0 Date Paid q- /q-04) By who? — '`e_! _ Receipt #� Ck# 700 By: County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 5/1/06 Page 2 of4 q-7',-) 03 iv �4 iD -P A-;' Applicant to complete the following: Do you have one of the following? [y YES ❑ NO Tax Map and Parcel Number and or; Address of use (include unit or floor if appropriate) ["YES ❑ NO P c i\j 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 [Er YES ❑ NO If so, Linty to at on, , l Var nce: YES 0 NO If so, List: Intake to complete the following: ❑' YES [9-50 Is use in LI, HI or PDIP zoning? Engineer's Report (CER) packet. If so, give applicant a Certified T"'VES ❑ 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 v e receive approval from Health Dept. FAX DATE ❑ YES LJ�NV Is on public water and sewer? ❑ YES MN6' Will you be putting up a new sign of any kind? proper Sign permit. Permit # ❑ YES 19' If so, obtain Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # ❑ YES NO Is this for sales of Fireworks? If so, obtain a copy of F/R permit. Permit # Proffers: ❑ YES [�J'NO If so, List: YYES ■ NO If ', i i i ` -7 (P ;- z 5/1/06 Page 3 of 4 Reviewer to complete the following: Square footage of Use: x V YES ❑ N Permitted as: (J�� Under Section: Q YTNA Supplementary regulations section: A Parking formula: In-0 910A I l Required spaces: ❑ YES ❑ NO Items to be verified in the field: Inspector Name & Date: Notes 960b -q? 5/1/06 Page 4 of 4