HomeMy WebLinkAboutCLE200600309 Application 2015-06-01Application for
Zoning Clearance
��eoni`ng Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
Tax map and parcel: 01� / Q�'f�� Ife) "' � �/ C J Existing Zoning:
Parcel Owner: C1 (1 Q 4tt Ac 4
Parcel Address: �d �&' M (hI 1 �l� i City [� Cl4' ` (o kj I l� State v `4 Zip z 201
(include suite or floor)
Contact Person (Who should we call/write concerning this project?): A14rX &,6WV-N
Address 179 t City (9 orkn) J+ l�L State v Zip Z2 l qL
lJ l
Daytime Phone l 7 31 912 J Fax it G ( 3q ) ` 7 / 1213 E-mail CAk ��t''^ � V q o `' (o,
Business Name/Type: -Fa "-, H ad64 (C_5�0,rc)
1
Previous Business on this site: �� ft(
Proposed use: 1;4 fA L �Q �
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.
Signature of Busi ss 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 w th the existing site plan.
] Thiq§ite comt. p with the sy e p)arl,as of tl�s date. _ _ , Q n _ 0 _ _ ✓
Building Official Date
Zoning Official Date Q
Other Officiala.Q a14-' • Date 'p
FOR OFFICE USE ONLY CLE #___
Fee Amount $."3t= Date Paid %r Xwho? Receipt # �Ck#-7 f By:
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 of4
Applicant to complete the following:
a , r
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 ❑'f ANO
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.
q
Zoning Tech to complete the followin
[I YES ❑ NO
If so is
,j o
Variance:
❑ YES 6 NO
If so, List:
compieie
❑ YES
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
D' -'YES ❑ NO !
Will there be food preparation? 5e
(6 `�� 4�
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from
Health Dept. FAX DATE as — v
L1 YES ❑ NO
O
Is parcel private well and septic?
If so, give app lcan a ea Ill apartment form.
Zoning review can not begin until we receive approval from
Health Dept. FAX DATE f L? ,Q 19 -_04
❑ YES ❑ NO
Is on public water and sewer?
❑ YES El"NO
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 proper Permit.
Permit #
❑ YES DNO
Is this for sales of Fireworks?
If so, obtain a copy of F/R permit.
Permit #
Proffers:
❑ YES NO
If so, List:
SP's:
❑ YES E� NO
If so, List:
5/1/06 Page 3 of 4
Reviewer to complete the following:'
Squar-, footage of Use:
F1 YES ❑ NO 11-1
Permitted as:✓eyyyy� Lk(
Under Section:. -
Supplementary regulations section:
Parking formula: L �
Required spaces: 4D 5W
❑ YES ❑ NO
Items to be verified in the field:
Inspector Name & Date:
Notes
5/1/06 Page 4 of 4