HomeMy WebLinkAboutCLE200600259 Legacy Document 2015-01-21CG I 1.
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Application for Zoning Clearance r ,.
OFFICE SE ONLY
❑ Zoning Clearance = $35 CLE #
PLEASE REVIEW ALL 3 SHEETS Check # Date: 2
Receipt # Staff:
PARCEL INFORMAT(I�ON
Tax Map and Parcel: C r Existing Zonin i lJa
Parcel Own
IM
;`� � Sale 1 n ll UA Zip 2
Parcel Address:�� �po Y�G-t7 i�Da City ( �r v ��� � State P 2 c� l
_
(inc ude suite or floor) -__
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PRIMARY CONTACT �^
Who should we call/write concerning this project?
Address :I qS Rt'o er Le4 `fir I u_'_ City State Zip 2 2
Office Phone: Y( 9�L) 9%j' -90 Cell # 9a% 25ff Fax # .2%- �/ d E -mail 1�LCS Peel oCDaoj. Cou.�
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PROJECT INFO TI N r I 1
BusinessName/Type: ice IUIo►t� �EP�r01 oqt� ''t 0�rT8u -SioK pLG
Previous Business on this site: 1"1 l LeW4^te Zvi
Proposed use: 04 ,Ce
Circle (if applicable): Fireworks / Christmas Tree
i e- oe-
SEE CONDITIONS OF APPROVAL IF THE CLEARANCE IS FOR FIREWORK OR CHRISTMAS TREE SALES (Sheet 1)
*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 accurat o the bes y lmowledge. I ha�ve,.read the conditions of approval, and I understand them, and that I will abide by them.
Signature 1����CJL — Printed SIL —Ip415 %�. LPL %d,✓
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APPROVAL INFORMATION
[ ] Approved as proposed [ ] 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 Date (T t
Zoning Official Date 1'Ta�o
Other Official
Date
•-------------------------------------------------------------- - - - - -- --------------------------------------------------------------------------
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: n(4,�34)) 29161 -5832 Fax: (434) 972 -4126 10/14/05 Page 2 of 4
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Applicant to complete the following:
& N
Do you have one of the following?
Tax Map and Parcel Number and or;
Address of use (include unit or floor if appropriate;
W/ N
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.
coning Tech to com
Violations:
Y /n
If so, LA t:
Vary ce:
Y /
If so, ist:
the followinz:
Intake to complete the following:
Is / >--
Is se in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
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
YI
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
on public water and sewer?
Y / Z
Will you be putting up a new sign of any kind? If so, obtain
proper Sign permit.
Permit #
Y /
W' there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Is /�Q
t#
Is t is for sales of Fireworks?
If so, obtain a copy of FIR permit.
Permit #
Prof
Y/
If so, List:
SP's:
Y
/�
If so, ist:
10114105 Page 3 of 4
Reviewer to complete the following:
Square footage of Use: .},� I
Permitted as:
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces:
Y/
Item o be verified in the field:
Inspector Name & Date:
Notes U V �s Q
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