HomeMy WebLinkAboutCLE200600227 Legacy Document 2014-10-03Application for
7,nninsr C1ParanPP /RCINP
Offing Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
Tax map and parcel: 03 ;o0 -60 -.0o f � ,i r 8 R Existing Zoning:
Parcel Owner: ,(� %Z -{1-2 1`"CJt-�
Parcel Address: q(,)oq 14 t•l rV k P_ A ,5J -a--tA GCity C % V i 11,6' State Zipz
(include suite or floor) p �O �./� � II
Contact Person (Who should we call /write concerning this project ?): �{'�'� t _S 6
Address q3 [,-7 I ' Ti-Je /1,1 K ce- ` u', Ie 149, city Sl et-1 + Nc, State 0 Zip ,�-)b I G4
Daytime Phone (S_71) . ,fib '- 7&d-0 Fax # ( ) (0(p I -0,. 63 LI E -mail C �, ^'1 �' Le k- C'1- i1
Business Name /Type: JZ T t=om 1 y L
Previous Business on this site:
Proposed use: , eve e-1 , N e� JC rV',CCS J1n , n i `fit - u e 5r,,-JMc As ej
, c,,nJ TeS-L--
I L I
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 th m.
Sign . fai ' f Business Owner or Agent Date ` ---- �-�- -""'
Backflow Device and /or "
Print Name f Current Test Data Needed
Contact ACSA 977 -4511, x 119
APPROVAL INFORMATION ?y
LA Approved as proposed [ ] Approved with conditions n
] Backflow 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 U,-
r
Zoning Official Date
Other Official Date
FOR OFFICE USE ONLY CLE It Lfo (a -- a 27 L f {
Fee Amount $ 35 C)0 Date Paid el' 19 0(0 By who? Ci. is`i ��•aa ��Receipt # 16202 3 Ck# .-t1 / U By: v
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
Applicant to complete the following:
Do you have one of the following?
4 too �4 HU A � XS �.c, AJ
YES ❑ NO C �n v f % r L/A- - aaW 01
Tax Map and Parcel Number and or;
Address of use (include unit or floor if appropriate)
F,]-'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; `d- ► q (0 0
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 0 NO
If so, List•
Variance:
❑ YES Z NO
If so, List
Intake to complete the following:
®'0 'Y'-ES ❑ NO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
*,
Engineer's Report ER) packet. ✓��J Q
❑ 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 Ee 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
ES ❑ NO
Is on public water and sewer?
❑ YES [D NO
Will you be putting up a new sign of any kind? If so, obtain
proper Sign permit..
Permit #
❑ YES /NO
Will there be any new construction or renovations?
If so obtain the proper Permit
Permit # � d 0 b —a„�9-
❑ YES MN6
Is this for sales of Fireworks?
If so, obtain a copy of F/R permit.
Permit #
Proffers:
❑ YES VNO
If so, List:
SP's:
❑ YES [� NO
If so, List:
5/1/06 Page 3 of
Reviewer to complete the following: q
Square footage of Use:
® YES ❑ NO
Permitted as:45���� '� @ai�luyn ° / e�NeP�- i�j�19���a''Z•
Under Section: 2 -%. 2� 00)
Supplementary regulations section: lQ(� U S o C)
Parking Parkin formula: / ,P,, ° ,/ A-oo 5(4 qc�pj 4,) J
I
Required spaces:/s-(
❑ YES ,Z NO
Items to be verified in the field:
Inspector Name & Date:
Notes
5/1/06 Page 4 of 4