HomeMy WebLinkAboutCLE200600246 Legacy Document 2014-12-02Application for
Zoning Clearance
21-oning Clearanc = $35
PLEASE REVIEW ALL HEETS
Tax map and parcel: c Imo . 00 42 0018 7 Existing Zoning: io p m L
Parcel Owner: T o-LI -Q • _ LTe) h ^/ 0-7
$'� %RG�N��
el-a ��
Parcel Address: 111a (p W laz,L& ! 0w, d'.1 City ✓l,Q�p State V A.. ZipZ27N
(include suite or floor)
Contact Person (Who should we call /write concerning this project ?): � /t°!� +'t �� Q� " ✓ -#eLS 57`+ru
Address c2 e U 5&VfL 13,X ca) City -7-&:5 _!5,r/J State Zip 2�
Daytime Phone &db 2 t//— 3 3-6 / Fax # C_)
E -mail lean rn C� 4¢p-�_:. — tf cH.. , e- 0v-1
Business Name /Type: 4(-&-:5- '4;. —C ,9 b"e— ve
Previous Business on this site: 6n t c �����i-U1�
Proposed use: Dej e- &u S Ga't"r °G
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 of Business Owner or Agent Date
Print Name
APPROVAL INFORMATION
10 Approved as proposed [ ] Approved with conditions
[%�]/Backflow device and /or current test data needed for this site. Contact ACSA 977 -4511, x119.
[ o physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing site plan.
[ his site complies with the site plan as of this date.
Building Official Date �� o t-
Zoning Official Date 16 '�4
Other Official Date
FOR OFFICE USE ONLY CLE # 4
Fee Amount Date Paid 10- - By who? T 2eceipt # �3 /�4 Ck #, 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
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)
❑ 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.
Zoning Tech to c
Violations:
❑ YES [�KNO
If so, List:
Variance:
❑ YES [2/NO
If so, List:
the
Intake to complete the following:
❑ YES ZVv
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER packet.
❑ YES O
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 D TE
❑ 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
Health D pt. FAX DATE
YES ❑ NO
Is on public water and sewer.
❑ YES
Will you be putting up a new sign of any kind? If so, obtain
proper Sign permit.
Permit #
Z-'YES ❑ NO
Will there be any new construction or renovation??
If so, obtain the proper Permit.
Permit # ZOO (Q - OD 4V'7 S �qC G1-W
❑ YES NO
Is this for sales of Fireworks?
If so, obtain a copy of F/R permit.
Permit #
Proffers:
❑ YES ❑INO
If so, List:
SP's:
❑ YES E---'N'O
If so, List:
5/1/06 Page 3 of 4
Reviewer to complete the following:
Square footage of Use:
❑✓ YES ❑ NO W �'
Permitted as: gj/V " f MA o' TU tCe
Under Section: �A • a .) Cl) e. d5 • . '
Supplementary regulations section: VI i G
Parking formula: l o o 0
Required spaces: 11.
❑ YES ❑ NO
Items to be verified in the field:
Inspector Name & Date:
Notes
5/1/06 Page 4 of