HomeMy WebLinkAboutCLE200600294 Legacy Document 2015-02-10Application for
Zoning Clearance
J_!:�"Zoning Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
Tax map and parcel:
Parcel Owner: er-j o ues S .SJ M N't-C —_—a_ A-V(
Existing Zoning:
a-r.► L- c / S 71/x'
Parcel Address: GS0 t LA-fJE— STr A City e,*4A- LoT7rY0 L44 _ State —%/A
(include suite or Iloo )
Contact Person (Who should we call /write concerning this .project ?): ��� TK--AA A,S
Address PO (bx ZS'fS City e- Vt LL
Zip2' Zg a ,
State ✓A Zip ZZ o'L
Daytime Plione 81y) gilled= Fax "3 2-1T-736 E-mail ��✓�✓S �aLt���1S. c
Business Name /Type: -D C j t rA_j ?AA ^r r- J O L->j T 1 0-rJ S Lt- e
Previous Business on this site:
w A
C �C
zRty LI
Proposed use: S 43
(Ly 1.4
7 t i tj -fr-L
c
P.M ^M 1
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 b th m.
1pe-e-X A Tu-vz_ LC)
20 a
Sig re of Business Owner or Agent Date
Print Name
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 complies with the site plan as of this date.
Building Official
Zoning Official
Other Official
Date ( 0 (-.
Date 07
Date
FOR OFFICE USE ONLY CLE # 7,000— Zq
Fee Amount $ q5,00 Date Paid ; P By who? Q� Receiiri # _6 319 7 I Qg 0 By:
I o•�j U n
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 5/1/06 Paget of4
Applicant to�eolnplete the following:
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)
K 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 complete the following:
Violations:
❑ YES LY NO
If so, List:
Variance:
❑ YES MINO
If so, List:
Intake to complete the following:
YE NO
Is use ii LI I or PDIP zoning?
Engineer's Report (CER) packet.
❑ YES [g"'NO
If so, give applicant a Certified
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
F-1 YES D�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. F E
YE/ / N
Is on TP), blic water and se er?
❑ YES' - O
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 pr p Permit.
Permit # 14
❑ YES O
Is this for sales of Fireworks?
If so, obtain a copy of F/R permit.
Permit #
Proffers:
❑ YES
If so, List:
SP's:
❑ YES NO
If so, List:
5/1/06 Page 3 of
Reviewer to complete the following: n go
'Square footage of Use: pl
'ES ❑ NO
Permitted as:
Under Section: aT 01- t 64)
Supplementary regulations section: vv�a
Parking formula:
Required spaces:
❑ YES ❑ NO
Items to be verified in the field:
n � .
Inspector Name & Date:
Notes
5/1/06 Page 4 of 4