HomeMy WebLinkAboutCLE200600261 Legacy Document 2015-01-21Application for Zoning Clearance
OFFICE USE ONLYI ,
❑ Zoning Clearance = $35 CLE #
Check # Date:
PLEASE REVIEW ALL 3 SHEETS Receipt # 1 Staff:
PARCEL INFORMAT O
Tax Map and Parcel: � � l AJ Existing Zoning
Parcel
Parcel Address: _ ` City �110— State Zip
__ (include suite or flood T� t�O �21rrT5.6Yl C*-
APPLICANT INFORMATION
Who should we call/write concerning this project?
VJ • 120 -,,J �sR
Address : �Yo (�&V -WLCtA CU, CAL City CJA' \4Lk., - State V k Zip I
Office Phone: (434 Cl-1q Cell # o'lgoL- 3C Fax #��SS� �'��¢G E -mail nEff4- Q 4 5rrICLrl
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PROJECT INFORMATION
Business Name /Type:
Previous Business on this site:
Proposed use: _F �A .lt an o �Cit�C11tiS V`CSZ3W� GM�C w—V�(fVIl�Q
ID CIA.\ t Al i 9, _ l 1 V-QA � v-q h O
Circle (if applicable): Fireworks / Christmas Tree nj A
SEE CONDITIONS OF APPROVAL IF THE CLEARANCE IS FOR FIREWORK OR CHRISTMAS TREE SALES (S.heet3)
*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 Printed
AP�OVAL INFORMATION
( ) Approved as proposed ( )Approved with conditions
Building Official
Zoning Official
Other Official
Date +`
N .- •
Date
Date
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County of Albemarle Department of.Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
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.
[:1 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 El NO
Is parcel on private well or ublic wIf private well, provide Hea Depant form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
❑ YES ❑ NO
Is parcel on septic or puDsewer?
❑ YES �/NO
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
16/yEs ❑ NO
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Coning 1'ecti to comps
Violations:
❑ YES ❑ NO
If so, List:
Variance:
❑ YES ❑ NO
If so, List:
Reviewer to complete the following:
Square footage of Use:
❑ YES ❑ NO
Permitted as:
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces:
❑ YES ❑ NO
Items to be verified in the field:
Inspector : Date:
Notes:
r aC)
the tollowin :
Proffers:
❑ YES ❑ NO
If so, List:
SP's:
❑ YES ❑ NO
If so, List:
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