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HomeMy WebLinkAboutCLE200600265 ApplicationApplication for Zoning Clearance Zoning Clearance = $35 PLEASE REVIEW ALL 3 SHEETS p1` ALli,.t' I�ttCIN�P Tax map and parcel: 07 go © ^- O Q — 0 O -- 0 / ID O Existing Zoning: 1 f" D S Parcel Owner: 01yeaa f �as yc�� �Fc►d .`)I'lapplw t3 �G�2 r'�t� Parcel Address: P D, City 1-t l' 1 �1f'G'Sl� f I I E State V (-t . Zip (include suite or floor) Contact Person (Who should we call /write concerning this project ?): / U i i A )114 Address 2307 De f 1 rm & cd LzL m&-- City [� &S t)( State V4 Zip z 2 C Daytime Phone (43J Zg 6 - f l �"8 Fax # (__) E -mail Business Name /Type: 13oU 9c- OcA -tc3 6 1- 4M e_t'tC;1 !�--once uoa l l 1ae_kso•n 9 -rely &uf yl cd i Previous Business on this site: Proposed use: ; t� C2.4— 1'+ t^ f "1' Wl c"l S 1 0 1 1016 -Ti/ ge 3 SEE CONDITIONS OF APPROVAL IF THE CLEARANCE IS FOR FIREWORK OR CHRISTMAS TREE SALES (Sheet 1) Circle (if applicable): Fireworks / 6istmas 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. rr,�l�ld� Be- Signature of Busine E Ow o , Agent Date lrl r l Print Name IJ 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 co Rlie� with thesite plan as of this date. Building Official Zoning Official -Ottmr Official j "W5 FOR OFFICE 1 Fee Amount S ,R ONLY C pLE, # ate- Date Paid y who? t" C ��" Date (d 8-I 0(6 Date 11 Date (143• -b Receipt # Ck# 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 oN Applicant to complete the Following: Z 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. Zoning Tech to co Violations: ❑ YES ❑ NO If so, List:. Variance: ❑ YES ❑ NO If so, List: the Intake to complete the following: ❑ YES ❑ NO Is use in LI, HI or PDIP zoning? Engineer's Report (CER) packet. If so, give applicant a Certified ❑ 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 ❑ 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 ❑ NO Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # ❑ YES ❑ 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 Reviewer to complete the following: Square footage of Use: ❑ YE� ❑ NO Permitted as: ON Under Section: Gi,l&OVA Supplementary regulations section: —14 (- Parking formula: Required spaces: (C/ PoMzb4n 26 ❑ YES ❑ NO Items to be verified in the field: Inspector Name & Date: Notes 5/1/06 Page 4 of 4