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HomeMy WebLinkAboutCLE200600242 Legacy Document 2014-12-02Application for Zonin g Clearance Z12oning Clearance = $35 PLEASE REVIEW ALL 3 SHEETS Tax map and parcel: 11 e. + Existing Zoning: Parcel Owner: 4.40 Parcel Address:��-3 f L L2&2& Y P 1'2 Vi � City 6911­0,4Z State Yez > Zip ZZ o (include suite or floor) Contact Person (Who should we call /write concerning this project ?):QYP / Address City State y'a Zip Z ,�5) Daytime Phone "t .2;--,3 1 /- 4,T _5' Fax # L_) E -mail Business Name /Type: �19 y �no,, 2nss a (J y'Ck.i -4 Previous Business on this site: /(62 5 , T 27 0 Proposed use: 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 AA a •r e nn— yr t,(_) Print Name AROVAL INFORMATION [ vJ Approved as proposed [ ] Approved with conditions [ ackflow 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. [ 1 This site complies with the site plan as of this date. Building Official Date j o ! 3 C, Zoning Official _ Date 17� `23 a (, Other Official yn Date FOR OFFICE USE ONLY CLE # . /-� bee Fee Amount $ id© Date Paid Pp. -5008y who? /Yip t e rycL 1;; rP VeLl 1 Receipt # �Ck #�j�/ / 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 of 4 Applicant to complete the following: Do you have one of the following? Rr ES ❑ 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. Tech to complete the Violations: ❑ YES Rr NO If so, List: Variance: ❑ YES [j3 NO If so, List: 0-f 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 1�s �0 0� ❑ YES ©-1�0 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 De FAX DATE YES ❑ NO Is on public water and 14�1 ❑ YES 0-�O Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # ❑ YES Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # ❑ YES Is this for sales of Fireworks? If so, obtain a copy of F/R permit. Permit # Proffers: ❑ YES [2/NO If so, List: SP's: ❑ YES © "NO If so, List: S-6 � O d + +1 • 0 5/1/06 Page 3 of 4 Lq,s 1.6-1 Reviewer to complete the following: Square footage of Use: ' d-i Dd [ ES ❑ NO Permitted as: (;JA -k VK &OAC A rylM4- Under Section: Supplementary regulations section: �^+ A I Parking formula: 1 b 0 d K F A Required spaces: ❑ YES [ /NO Items to be verified in the field: Inspector Name & Date: Notes 511106 Page 4 of 4