HomeMy WebLinkAboutCLE200600298 Legacy Document 2015-02-10Application for
Zoning Clearance
�ning Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
Tax map and parcel: �) to CEO �D IQ L/"�:5100 Existing Zoning:
Parcel Owner: /
Parcel Address: City State Zip
(include suite or floor)
Contact Person (Who should we call /write concerning this project ?):
Address ,! lU� /7P//�/'1 i %.Szr e r� City ?C_ �, K,,� c�� State A/W Zip z_
Daytime Phone 13 _L4_S ' 0 Fax # d /� un,A 9 1-78 C S7�7P — U!4- US ^/
Business Name /Type:
Previous Business on this site:
Proposed use:
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. %.
Si of Bu 'ness ner or
Agent Date ac �`¢`�'v r,� °'"`'' �� ° "�
Sig ,7t %� L o Vn g g Cu:"rrrixi ttt'.
Print Name Contact AC, A``,. 677-4511, x 119
APPROVAL INFORMATION papaa� rs;�� ;91),L Iua��n
[ Approved as proposed [ ]Approved with conditions am/pur amp-,;3(1 M.0" -)qf�
[ Backflow device and/or current test data needed -for this site. Contact ACSA 977 -4511, xl 19.
[ ] 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 , O
Zoning Official Date ?t
Other Official Date
FOR OFFICE USE ONLY r y/d CLE
Fee Amount $ �. f A"('}Date Paid By who? �Q._ R c�,n a 'R ceipt # - Ck >A By:
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 complete the following:
Do you have one of the following?
I YES ❑ NO
Tax Map and Parcel Number and or;
Address of use (include unit or floor if appropriate)
O4YES ❑ 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
4 YES ❑ NO
If so, List:
Variance:
❑ YES dNO
If so, List:
V44�SSD
Intake to complete the following:
[_1 YES ❑/O
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
❑ YES [t3-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 �tO
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
❑]YES ❑ NO
Is on public water and sewer?
❑ YES ❑ NO
Will you be putting up a new sign of any kind? If so, obtain
proper Sign permit.
Permit # yv'wi l li�r7�
YES F-1 NO /J
Will there be any new construction or renovations?
If so, obtain the "proper� it.
Permit # /
❑ YES D—NO
Is this for sales of Fireworks?
If so, obtain a copy of F/R permit.
Permit #
Proffers:
V YES ❑ NO
If so, List:
'7-,,4,d 0 70 -) 31
A - /97) �Tz 3
A 17-70 13Y
ZJkA w
n^ �_ 7 / — "'1 9 ir_ AA f
SP s:
FA YES ❑ NO
If so, List:
ou
so -/ )-1 -oi
6 ZJ---q
71-0 S7 -Zoas -c
1:1' Ate,
Sin 0 T6 `04, ) —A,, N., /Q. Z:,.�Rr <99)
/ -60
"Od S��i�• ! tj
5/1/06 Page 3 of
Reviewer to complete the following: /
Square footage of Use: �� J�
YES ❑ NO
Permitted as: Q e, CL-A � 49 ea�/ )
Under Section: 2 -2, I C3
Supplementary regulations section:
Parking formula: .51 G,
Required spaces: L (A'A' iki
❑ YES ❑ NO
Items to be verified in the field:
Inspector Name & Date:
Notes
5/1/06 Page 4 of 4