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HomeMy WebLinkAboutCLE200600225 Legacy Document 2014-10-03Application for t Zoning Clearance 2�v ❑ Zoning Clearance = $35 PLEASE REVIEW ALL 3 SHEETS Tax map and parcel: © F1 "' 00-00 —MZ0 1 Existing Zoning: Parcel Owner: D2060X 11' __A560GI�S y / Parcel Address: 3a5 FOLA/ i`��4 kin 5t4 of City Gro State V k Zip ROSS (include suite o floor) Contact Person (Who should we call /write concerning this project ?): & NaA1ri Address PC) Clio City ­ &tg a in wcr I State VA Zip -)A'14 Daytime Phone ( 3" " 0793 Fax # LJ Business Name /Type: E -mail hkaMa (Z� t"616% S� - /L. — I � oa l Sti ci 0'2 Previous Business on this site: N tjpNlFjUNA.IC! H Proposed use: Mog I 5b0 tt A Inm2pr" rtdc�s , CRf a�1�$ � swa- — SEE CONDITIONS OF APPROVAL IF THE CLEARANCE IS FOR FIREWORK OR CHRISTMAS TREE SALES (Sheet 1) Circle (if applicable): Fireworks I. 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. C1 l,91 a6 Backflow Device and /or Current Signa a siness Owner or Agent Da a eeded H A N I K A\ � Contact ACSA 977 -4511, x 119 Print Name AYFPROVAL INFORMATION V] Approved as proposed [ ] Approved with conditions [ ckflow 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 sit complies with he site plan a of this date. �fi1 dUiV G(0 nof-�� � dl �—�V 2405 S%I v�J bs�('UYioll`G�MCeGCO �v . V Building Official _ Date (, Zoning Official Date Other Official Date �� FOR OFFICE U NLY CLE # QD b 6 —n- C� Fee Amount $ Date Paid who? Receipt # lO 0 Ck# 1 a R By: Ani IJUUIILY Ul AUUMILUi 1C lJVFU1 L111C11L Ul <.U111111U111Ly "rV V1UF111C11L 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 5/1/06 Page 2 of4 r�> Applicant to complete the following: t 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) D L ES h ❑ NO o 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• o o � S n Variance: ❑ YES NO If so, List: Intake to complete the following: ❑ YES ❑ NO Is use in LI, HI or PDIP zoning? Engineer's Report (CER) packet. If so, give applicant a Certified ❑ YES NO Will there Afood preparation? If so, give applicant a Health Department form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE ❑ YES 'Z 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 Health Dept. FAX DATE YES ❑ NO Is on public water and sewer? YES ❑ NO ill you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # V9YES ❑ NO 11,1 there be any new construction or renovations? If so, obtain the roper Permit. � Permit # f -' 300 G ❑ YES R NO Is this for sales of Fireworks? If so, obtain a copy of F/R permit. Permit # Proffers: YES ❑ NO If so, List: SAI q q -I 1 SP' : V❑�YES ❑ NO 19 —1 P1A`y1*1+ TM P If so List: ,0,�a00t- 5/1/06 Page 3 of 4 Reviewer to complete the following: Square footage of Use: YES ❑ NO�� Permitted as: IsC 1 G Under Section: Supplementary regulations section: V Parking formula: / bb a Required spaces: / ❑ YES [/ NO Items to be verified in the field: Inspector Name & Date: Notes a ,a, 5/1/06 Page 4 of 4