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HomeMy WebLinkAboutCLE200600275 Legacy Document 2015-02-10Application for g,�r ' Zoning Clearance b oning Clearance = $35 PLEASE REVIEW ALL 3 SHEETS Tax map and parcel: 041 V O — O 3 — Co - 016eo�Existing Zoning: 14 G Parcel Owner:_ t ay-ds, t) cwV cql OY :Tan 1IG , V - \ / Parcel Address: 3O qa A Serk1�r DY • City C rh ar 4 o -H55s 191 d fJ State V Zip22�� I (include suite or floor) n r (� ,{ Contact Person (Who should we call /write concerning this project ?): I � ACC rci I V C1.1' txxL ` �1, �/ Address 1" �O°c� City(R ckc- Ce rs V lI I t ) (State V � Zip ��S Daytime Phone 3y 9F5" 6 35 Fax # 3 ( q�S� �v 3 3a E -mail rr, k na�,� -T; Is Qn �6�mC{) CbYY) Business Name /Type: V'4(5 5 '10y) A o i -il e-P-) Previous Business on this site: 10 t" 0`t F"5 16Y1 C✓A Proposed use: boo ��SS IC Y-, al 0; l Ce ) 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. tzktA� Signature of B siness OvMer or Agent Date ru pa c 1 is Print Name APPROVAL INFORMATION Current Test Data Needed [L4 Approved as proposed [ ] Approved with conditions Contact ACSA 977 -4511, x 119 [ Backflow device and /or current test data needed for this site. Contact ACSA 977 -4511, x1 19. [VNo 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 ( y : Zoning Official Date Other Official Date FOR OFFICE USE ONLY CLE # ,ZO© to7cl % 5 . Fee Amount $ .q J .C'p Date Paid f I-0-OfpBy who? CM44a;C -0 cr' ' t # 1098 9 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 of4 App) icant to co tiiplete the - olloV`r ing: Do you have one of the following? $4 YES ❑ NO Tax Map and Parcel Number and or; Address of use (include unit or floor if appropriate) , YES ❑ NO Do you have a Floor Plan (sketch or an architectural drawing) that includes the following, and if so please provide it with the application? The total square footage of the use and /or; (go S$. �4 The square footage of each room or area of use; V Use of each room or area If using less than the entire structure, note the location within the structure. Soning Tech to co Violations: ❑ YES ❑ 0 If so, List: Variance: ❑ YES [ NO If so, List: lete the Intake to complete t e following: ❑ YES 0 Is use in LI, HI or PDIP zoning? 'If so, give applicant a Certified Engineer's Report (CER) packet. ❑ YES 0K0 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 al T 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 9-/Es ❑ NO Is on public water and sewer? ❑ YES C]XO Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # ❑ YES Will there bVny w construction or renovations? If so, obtain the proper Permit. Permit # ❑ YES Voof Is this for sarewor ks? If so, obtain a copy of F/R permit. Permit # Proffers: ❑ YES E�/NO If so, List: SP's: ❑ YES dNO If so, List: 5/1/06 Page 3 of Reviewer to complete the following: Square footage of User r 0,-VES ❑ NO Permitted as: Under Section: Supplementary regulations section: �1 a Parking formula: � G Q1Z Required spaces: ❑ YES O Items to be verified in the field: Inspector Name & Date: Notes 5/1/06 Page 4 of