HomeMy WebLinkAboutCLE200600234 Legacy Document 2014-12-02Application for� '
9?A
Zoning Clearance
Z-0—ni g Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
Tax map and parcel: 0621 ,on aQ ._ `-✓0 131, r"7 L! jExisting Zoning: �°' 011 C
Parcel Owner: AC/1't.�'Y� -D/� -/LZ s f / -Y)O-77 O(�&J- TD 116
Parcel Address: 5 �� �t(S �� • % , City (jj)ni.�1Ct��`yt 4 �2 State VA* A Zip a_,afl I
(include suite or floor) 11
Contact Person (Who should we call /write concerning this project ?): d„.i's
Address 1 X60 I &"oe, r� a �r 4 Zf4 City CAy rf ar +es Q 1 GZ State Q� Zip
Daytime Phone ( O$ ", ( �i"7 -7 -b Fax # (_)
Business Name /Type: C_ \ iCy=— �t
Previous Business on this site:
Proposed use: az 5'rtG.\.t.�(6..v1�
E -mail
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 gent Da e
Print Name
APPROVAL INFORMATION
[ f4pproved as proposed [ ] Approved with conditions
[ckflow device and /or current test data needed for this site. Contact ACSA 977 -4511, x119.
[ physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing site plan.
[ n This site complies with the site plan as of this date.
Building Official Date
Zoning Official Date
Other Official t UI G( Date a' /0 0_7
FOR OFFICE USE ONLY CLE # V6�i- VL'4
Fee Amount $r aQ Date Paid L% Q )
-By who? 'r'1 c v,
d —L: 2 Cwi�&A Receipt # I Ck# � i!JA� By:
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 5/l/06 Page 2 of4
Applicant 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)
[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.
)cOsq
Zoning Tech to c,
Violations: Z,
❑ YES
If so, List:
Variance:
❑ YES DNO
If so, List:
the fi
Intake to complete the following:
❑ YES NO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
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 9-N0
Is parcel on rivate well and septic?
If so, give app' licant 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 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 #
❑ YES [ V0
Is this for sales of Fireworks?
If so, obtain a copy of F/R permit.
Permit #
Proffers:
❑ YES [ NO
If so, List:
SP's:
❑ YES [NO
If so, List:
5/1/06 Page 3 of
Reviewer to complete the foil IwiM
nfu
Square footage. of Use:
Q AYES ❑ NO
Permitted as: /� r
Under Section: ��' l • a - l l�'1)
Supplementary regulations section: ✓ tr( eA
Parking formula:
Required spaces:
❑ YES ❑ NO
Items to be verified in the field:
Inspector Name & Date:
Notes
5/1/06 Page 4 of 4