HomeMy WebLinkAboutCLE200600230 Legacy Document 2014-10-03Application for '
Zoning Clearance
R
Zoning Clearance = $35
+" PLEASE REVIEW ALL 3 SHEETS
Tax map and parcel: 493,2 00— 66-66 —Og3OO __ Existing Zoning: 10ID M C. V'
Parcel Owner: JENNWER M. Wyon 0.0..., M.S
Parcel Address: 729 CONJVL) okivE City
(include suite or floor)
P. C.
c oak ,orrtisv?rtF State V
Contact Person (Who should we call /write concerning this project ?): _
Address l y i 8 C FDAR wooD C r City
Daytime Phone (!!) 295- ill 2 Fax # L___)
.itrNNir&Q M. Dixon D.D. .S
c)4 qn k o r rF SwLL F State VA
Zip 224//
Zip 22 7.93
E -mail enn,' %r ckondod s 0 ha +Y,q,' /• �osn
Business Name /Type: CNAlz1. orrHSvittE PCH DIATRi - DENriSTP
Previous Business on this site:
Proposed use: PED A rrr,c DFMTAI PRA CTl C!°
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.
Signature oUJ3usi:ppis Owner or Agent
JENN1r-FP M. DIX-A
Print Name
VAL INFORMATION
,ed as proposed
Date
[ ] Approved with conditions
2(01200 (o
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 site complies with the site plan as of this date.
Building Official Date
Zoning Official NiSM= Date
Other Official Ll Date
FOR OFFICE USE ONLY CLE # ZQ (P —� 6 !/ j�l
Fee Amount $, Op Date Paid 2' � -00 By who? �teceipt # QL!Q k #� ®� By: bG
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 of
y A f�licant 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)
BYES ❑ 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
v io rnons:
YES ❑ NO
Tf en Nct-
Variance:
❑ YES ❑ENO
If so, List:
b L NNS '
%_'
Intake to complete the following:
❑ YES NO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CE acket.
[:1 YES 0
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 9--90
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
EP-IES ❑ NO
Is on public water and sewer?
AYES ❑ NO
Will you be putting up a new sign of any kind? If so, obtain
proper Sign permit.
Permit #
❑ YES 9,NO
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
❑ YES 'CO
Is this for sales of Fireworks?
If so, obtain a copy of F/R permit.
Permit #
[] YES ❑ NO
If so, ' t: M^ M ei 3 v
Ll.�
n�%S [-] NO
_• Y /
All
our
5/1/06 Page 3 of
Reviewer to complete the following:, `
Squa.i•e footage of Use: Zd �( l
[YES ❑ c
Permitted as:
Under Section:�1c , 8"• I ` I - b ll
Supplementary regulations section:
Parking formula: r�
Yv ' \.
Required spaces:
S�
❑ YES [� NO
Items to be verified in the field:
Inspector Name & Date:
Notes
511106 Page 4 of 4