HomeMy WebLinkAboutCLE200600299 Legacy Document 2015-02-10Tax map and parcel:
Parcel Owner:
Application for
Zoning Clearance
Zoning Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
(O t11— bo - 00 " 0 ) ._1>_00 Existing Zoning: Q LA EJ
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Parcel Address: ' °23 2 S--10,Aey R.l a�� �� City CJ-VWZ L0 l FE7,1-41 State V A Zip
(include suite or floor)
Contact Person (Who should we call /write concerning this project ?): '11 202'1 21- D Kp r L Art j
Address 12 3 2 STOr1 Cy 1 't D 6-C 4Ai) City C -V4 PN-L -y T_r6:_S lit, `- WState `i%-\ Zip 22,902
Daytime Phone M34 Fax # ( E -mail yid Kc;_pr 1&V) &2eA bOd b
Business Name /Type: pr% ItAc_ SC.- \_ o o
Previous Business on this site: ttr t JPr� i SC �yc
Proposed use: P r- t �i � e SC y0 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
abidey by them. J
�7Vczr►ti.i..¢ D � C l �// s-1o20046
Signature of Business Owner or Agent Date
Print Name
gvice and/or ,n_ct Data deeded
APPROVAL INFORMATION
[ ] Approved as proposed
[ Approved with conditions
(Contact ACSA 977 -4511, x
Yf "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.
[VI This site co plies with the s{iitt/e� plan as o(f�this daatte�
Building Official �— Date f ( `l
Zoning Official Date
Other Official Date
FOR OFFICE USE ONLY CLE #�
Fee Amount $ /VV -r*V. Date Paid Q- /5•0D By who? Receipt # IV 0-r%A Ck# By:
,1 �l
County of AiDemarle Department oI Community Develupment
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 5/1/06 Page 2 of 4
A,plicant to complete 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)
YES ❑ NO
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
Vio tions:
[ZYES ❑ NO
If so, List:
J- aj ( 4
�fpu Q,�ri p.(GVn- F-c.C,
lete the
Variance:
F-1 YES NO
If so, List:
Intake to complete the following:
❑ YES NO
Is use in LI, H or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
❑ YES NO
Will there b f od 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 i ate 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 F] NO
on public water and sewer?
❑ YES] NO
Will you be utting up a new sign of any kind? If so, obtain
proper Sign permit.
Permit #
IYES ❑ NO
11 there be any new construction or renovations?
If so, obtain the proper Permit.
Permit # Q 000& oa.S V o A-T
❑ YES NO
Is this for sales of Fireworks?
If so, obtain a copy of F/R permit.
Permit #
Pr ffers:
[ YES ❑ NO
If so, List:
-L" le-A
SP's:
®' YES ❑ NO
If so, List:
5/1/06 Page 3 oP4
RMewer to complete the fol ink ,
Square footage of Use: � &� -�z
V YES ❑ NO
Permitted as: I
Under Section: �2p [al - A-6 1
Supplementary regulations section:
`
Parking formula: ► r4t,I� 1 /
Required spaces:
[yYES ❑ NO
Items to be verified in the field: 66 V AKeei`
Inspector Name & Date:
Notes
5/1/06 Page 4 of 4