HomeMy WebLinkAboutCLE200600292 Legacy Document 2015-02-10Application for Zoning Clearance
OFFICE USE ONLY
CLE # 7,00&
oning Clearance = $35 Check# -1,5q
PLEASE REVIEW ALL 4 SHEETS Receipt # to 3 i (4 5
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Date: -e-) U0
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PARCEL INFORMATION
Tax Map and Parcel: / —7 9 r9 Existing Zoning
Parcel Owner: 17r� scndl�ya. L%.brt-
Parcel Address: 1496 P&rtayS MA-n- PL. 4:6 Z6l5 City. C,1ncrloi4,4u11l_ State Vh Zip z2nI�
--------------------------- - (include ---------suite ------or -- - flood
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APPLICANT INFORMATION
Who should we call /write concerning this project?.._pt1Pi r4 a1 4e.c,r4-
Address: 17• V . bX IS X'3 City Goo rlb t s�illa. State y P, Zip 7.7-9 07-
Office Phone: (`i34) lrZ -1-7 frO Cell #
Fax # °I T2 :) S I Z E -mail
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PROJECT INFORMATION
Business Name /Type: Me eA; c a,1 i2n0.c.-t L r_
Previous Business on this site: Q but IZ-I qe_
5
CAc bey- ��-ti�
Proposed use: h GCi C-0. 9'b.C,+LQ_ - e hd0L "AtA t4 pa n
Circle (if applicable): Fireworks / Christmas Tree
SEE CONDITIONS OF APPROVAL IF THE CLEARANCE IS FOR FIREWORK OR CHRISTMAS TREE SALES (Sheet 1)
*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 m knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed j7. ,r. 6C41akJ11-
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APP VAL INFORMATION Backflow Device and /or
( V• Approved as proposed ( )Approved with conditions CUrCe>dt Test Data Needed
Contact ACSA 977 -4511, x 119
Building Official c ✓ -4-- -.
Zoning Ofricial
Other Official
Date t 4_ -z - b
Date 0
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
3/28/05 Page 2 of
1` "Apo icant to complete the following:
N
o you have one of the following?
Tax Map an4Tarcel Number and or;
dress of use (in Jude unit or floor if appropriate;
(Y)/N
Do you have a Floor Plan (sketch or an architectural drawing) that
includes the following, and if so please provide it with the
application?
Th total square foota of the use and /or;
The square oo'age o 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.
to complete the follo
Y/
If so,
0 riance:
/N
�
Intake to complete the following:
Y/N
Is I, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y
Wil ere 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
Y
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
Ts N
Ts- on public water and sewer?
U nN
ou putting up a new sign of any kind? If so, obtain
proper Sign permit.
Permit #
Y
W Il thPtain any new construction or renovations?
If so, o the p roper Permit.
Permit #
oor Isales of Fireworks?
If so, obtain a copy of F/R permit.
Permit #
N
�/ N
so,s fit,; (r � ✓ ✓ � � �/
3/28/05 Page 3 of 4