HomeMy WebLinkAboutCLE200600282 Legacy Document 2015-02-10Application for
Zoning Clearance
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❑ Zoning Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
Tax map and parcel: _32,— 3-7(
Parcel Owner: L Ci i vd v, r
Parcel Address: 3'/741 SG.sliae /G 7`°�'/ City
(include suite or floor)
Contact Person (Who should we call /write concerning this project ?)
Address 10 Q e-x Z 0 S—
Daytime Phone Y _D / Z - 3 Y 3 j Fax # L�
Business Name /Type:
Existing Zoning:
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C 44, �• l! vi `XeState V 4 Zip q 11
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City
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E -mail � r e 1 z
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Se.rvj dr►ry ( S I GJ C v'� f�l�4 J 'T*-G e y (/�'l �tS�C1 o
Previous Business on thiiss site: Me - Cee
Proposed use: r1 �' S�/y 4 S fi'h e e
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VRCQ014,
SEE CONDITIONS OF APPROVAL IF THE CLEARANCE IS FOR FIREWORK OR CHRISTMAS TREE SALES (Sheet 1)
Circle (if applicable): FireworksC=ristmasTree
*This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move the use to a new location, a
new Zoning Clearance will be required.
I hereby certify that I own or have the owner's permission to use the space indicated on this application. I also certify that the information
provided is true and accurate to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will
abide by them.
Signa re optusiness Owner or Agent Date
Gre r e es er
Print Name
APPROVAL INFORMATION
[ Jef Approved as proposed [ ] Approved with conditions
] Backflow device and/or current test data needed for this site. Contact ACSA 977 -4511, x119.
] No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing site plan.
] This site complies with the site plan as of this date.
I
Building Official Date i t �� CY
Zoning Official Date i 1
Other Official Date f
FOR OFFICE, U 56)NLY I CLE # a L— A$ I
Fee Amount $ �J / Date Paid I o4.y who? Receipt # Ck# lr1'�oV 1
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 5/l/06 Page 2 of4
Applicant to corflpiete the ioiiowing:
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.
Tech to complete the
Violations:
Vr YES ❑ NO
I�sA, List:
V I (2 R0 o -',i 0
Variance:
[J/ YES ❑ NO
If so, List:
mr
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 t 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? a 10 jo/„
If so, give applicant a Health Department fforrr ^\
Zoning review can not begin until we receive approval from
Health Dept. FAX DATE
❑ YES ❑ NO u of kk at„ k j h. v(�- kl t G�
Is on public water and sewer?
j& YES ❑ NO
Will you be putting up a new sign of any kind? If so, obtain
proper Sign permit. Q
Permit # T& or y J
Arr
❑ YES NO
Will there b7any 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 [2 NO
If so, List:
SP's:
[YES ❑ NO
If so List:
9Qa M4 - 5�
5/1/06 Page 3 of
Rdviewer to complete the folio: ing:
Square footage of Use:
YES _ ❑ NO
Permitted as:
Under Section:
Supplementary regulations se,tZ,n:
g
Parkin formula:
Required spaces: �l
❑ YES ❑ NO
Items to be verified in the field:
Inspector Name & Date:
Notes
5/1/06 Page 4 of 4