HomeMy WebLinkAboutCLE200600258 Legacy Document 2015-01-21Tax map and parcel:
Application for
Zoning Clearance
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Zoning Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
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Parcel Owner: 0 R;3 VICE Q
113 vd
Parcel Address: ���ji o1� ✓�O� City
nclude suite or floor)
Existing Zoning: Z 44
A- State V4 I Zip
Contact Person (Who should we call /write concerning ing this project ?): �7;w At
Address AQ�rC ��$5e "4-_ City - 5601%'A-1 State 4 Zip
Daytime Phone (�O- / 7 Y ' " Fax # U E -mail L.7/*, a ,4 iW4�W- )&
Business Name /Type:- D��'��n�
Previous Business on this site: :7A) ),=A_-- V AJ T
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 agcurate t9r t} e best of my knowledge. I have read the conditions of approval, and I understand them, and that I will
nlliA by them 'Or -/
gnatutre of Business(O er or,�l,�ent�j,�
Print N
Date
APPROVAL INFORMATIO
Approved as proposed (' l4/, R [ ] Approved with conditions
[ ] 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
Zoning Official
Other Official
Date i; ''34
Date o o fo
Date
FOR OFFICE USE ONLY CLE #
Fee Amount $ 3$~ Date Paid .Vf By who? / t1A.1CX E$ Receipt # 620JO Ck# By: xg • /
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 l
Do you have one of the following?
[VYES ❑ NO
Tax Map and Parcel Number and or;
Address of use (include unit or floor if appropriate)
❑ YES 9 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 ❑ NO
If so, List:
Variance:
❑ YES ❑ NO
If so, List:
the followin
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 [?j'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 ❑ 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
❑ YES [�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 O' NO
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
❑ YES [✓r NO
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 4
Reviewer to complete the following:
Square footage of Use:
❑ YES ❑ NO
Permitted as:
Under Section: (� a A X M� QOA,ttM l�tdk�.
Supplementary regulations section:
Parking formula:
Required spaces:
❑ YES N0
Items to b verified in the field:
Inspector Name & Date:
Notes
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5/1/06 Page 4 of 4