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HomeMy WebLinkAboutCLE200600277 Legacy Document 2015-02-10AppllcaLlon for Zoning Clearance���� /RCANP Zoning Clearance = $35 PLEASE REVIEW ALL 3 SHEETS Tax map and parcel: 79 3 Existing Zoning: Parcel Owner: F S! 6 Parcel Address: -1 �fA y\A'y il:i �& ( Jk C it� �wt(,� f V ' "t State 1`V Zip Rai /i (include suite or floor) Contact Person (Who should we call/write concerning this project ?): UI Y `"n 0k j Address ` S i "�'1iA �i `,�yL� \L -C s 7.5 �' � L t City C V� �; d 1 b�'f`���� r �' State Zip si Daytime Phone Ply �1' SS Fax # ( cJi47r�l lylt'�-7 E -mail �fto $ ["1_5 P Q e Business Name /Type: (`e \as & r, Piy)&,y\(, -9- S, U—c- Previous Business on this site: I j Proposed use: ',-^ aA 6 Jwl J 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 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 , Business Owner or A ent Date Print NamJ Backtlow Device and/or Current Test Data Needed ftOVAL INFORMATION Approved as proposed [ ] Approved with conditions X ] 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 (( . to Zoning Official Date Z s Other Official Date FOR OFFICE USE ONLY CLE # 2-004077a 77 Fee Amount $ 3.5i o 0 Date Paid 1,I. 17-0 & By who? bl t o Receipt # 4' 993 Ck# -3113 I By; C5 U R .�� 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 of 4 Applicant to complete the following: Do you have one of the following? Q /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. Tech to complete the Violations: YES ❑ NO If so, List: Variance: ❑ YES M11NO If so, List: Intake to complete the following: ❑ YES Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Rep, ort t(CER) packet. ❑ YES LI�Nv 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 HMO 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 ES ❑ NO Is on public water and sewer? ❑ YES l�J'Nv Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # ❑ YES E-11K Will there be any new construction or renovations? If so, obtain the proper-Permit. Permit # ❑ YES EA Is this for sales of Fireworks? If so, obtain a copy of F permit. Permit # Pro ers: YES ❑ NO If so, List: SP's: [V YES ❑ NO If so, List: 5/1/06 Page 3 of 4 n Reviewer to complete the following: Square footage of Use:J YES ❑ NO t� Permitted as:y -� i ej`an�i1.i c cs Under Section: ��.'`� . �, !J '� Z3• Z l �3� Supplemon ary r�tirrrts-ser4tion: / s i Ad 7 Parking formula: Required spaces- YES �5 ❑ YES O Items to e verified in the field: Inspector Name & Date: Notes 5/1/06 Page 4 of 4