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HomeMy WebLinkAboutCLE200600308 Application 2015-06-01Application for Zoning Clearance oning Clearance = $35 ItQomPLEASE REVIEW ALL 3 SHEETS _ Tax map and parcel: 7�� /� 4b ' g�1 �G�Z�("/( 1130Existing Zoning: Parcel Owner: (� [,f [.��. /LCA ` C _(,k, Parcel Address: 1770 City (include suite or floor) State V4 Zi P2 // Contact Person (Who should we call/write concerning this project?):'+ ►� G Address !1w q l�i"L1'1 �`l G�i3� l�C �i? City U +dt State Zip 2a Daytime Phone (% z 33�a - 01-22 Fax # (r ) E-mail Business Name/Type: Previous Business on this site: Proposed use: GG1'+. � l � ✓LS �P�4�/a/.r;rGGh '� E �., t� (A1 �J lei 0 �G/"' 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. aZ Signature of Business Owner or Agent Date Print Name APPROVAL INFORMATION [ 0 Approved as proposed [ ] Approved with conditions [ Q,0, ckflow 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 detennination of compliance with the existing site plan. [ ] This site complies with the site plan as of this date. - Building Official Date Zoning Official Date 11,70 Other Official Date / o� FOR OFFICE USE ONLY CLE #Q f 41— 'c5" Fee Amount $' '� C0 Date Paid i"27^6y who? Z. (';%1s1M Receipt # Ck By: MG County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126 5/1/06 Page 2 oP4 Applicant to complete the following: Do you have one of the following? ©,AYES ❑ NO Tax Map and Parcel Number and or; Address of use (include unit or floor if appropriate) Q 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 Violations: ❑ YES [0 NO If so, List: Variance: ❑ YES 'A NO If so, List: the followin Intake to complete the following: ❑ YES El NO Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. ❑.�` YES ❑ 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 ], --,�17- 00 ❑ YES Q 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. FAX DATE © YES ❑ NO Is on public water and sewer? ❑ YES Z NO Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # ❑ YES �0 NO Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # ❑ YES Q NO Is this for sales of Fireworks? If so, obtain a copy of F/R permit. Permit # Proffers: ❑ YES VNO If so, List: SP's: ❑ YES —DINO If so, List: 5/1/06 Page 3 oP4 Reviewer to complete the following: Square footage of Use: 1 2-1 -7 ❑ YES ❑ NO // // Permitted as: h (`1�IGf 9kAJ6 II�Ti/Y'Vli�&/ Under Section: r} 5 - oZ- 1' ({ Supplementary regulations section: D Parking formula: Required spaces: �O ❑ YES [I/NO Items to be verified in the field: Inspector Name & Date: Notes 5/1/06 Page 4 of 4