HomeMy WebLinkAboutCLE200500145 Action Letter 2017-08-01c�
Application for Zoning Clearance
C# OFFICE I
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❑ Zoning CIearance = $35 Check # Aq Date:
PLEASE REVIEW ALL 4 SHEETS Receipt # 1101 Staff-
PARCEL INFORMATI N
Tax Map and Parcel: I nU-) CCk " t: tt C_,C' Existing Zoning C 1 Cg� en MSAAQ; 91A
Parcel Owner: Q o q e,'" L. n J e? S y L. t~
Parcel Address: )LI G Sac�%em Plccce CitC �State '` A Zip 90I
(include suite or floor)_
APPLICANT INFORMATION Who should we call/write concerning this project? ()auras ryl . ke n e)"
Address: )413 SaLike.ri P� e�,Sµ.�e a: CitlCg2,1d 'e5v.iMes. State QA Zivq �
Office Phone: (!OA Cell # Fax AN 9 1`7-9-mail
PROJECT INFORMATION
Business Name/lype: Ke n n 04
Previous Business on this site: hl %BR ; CCe' SL Rre-.0.5 ,,nC'I 0%cr3 aX`
Proposed use: eca 6SAc;"-ye- UCcli1LCA_`,o+'
SG'sw"LE�-S
Circle (if applicable): Fireworks / Christmas Tree
SEE CONDITIONS OF APPROVAL IF THE CLEARANCE IS FOR FIREWORK OR CHRISTMAS TREE SALES (Sheet 1)
*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 accura the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signa Printed -A'* on Z_s h . K r_� r..i Z A Y
--------------------------------
APPROVAL INFORMATION
( ) Approved as proposed
( ) Approved with conditions
Building Official Date
Zoning Official _ Date
Other Official Date
----------------------------------------------------------------------------------------------------- -------------------------------------------
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 9724126
3128/05 Page 2 of 4
Applicant to complete the following:
Y�N
Do you have one of the following?
Tax Map and Parcel Number and or;
Address of use (include unit or floor if appropriate;
4-yoY N
o 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.
:oning Tech to
Violations:
Y/N
If so, List:
Variance:
Y 1 N
If so, List:
the
Intake to complete the following:
YIN
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y l
Wil ere 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
Y /(�)
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
N
s on public water and sewer?
Y /�
Will you be putting up a new sign of any kind? If so, obtain
proper Sign permit.
Permit #
Y l
Wi&dw& be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Y
Is this for sales of Fireworks?
If so, obtain a copy of F/R permit.
Permit #
Proffers:
YIN
If so, List:
SP's:
YIN
If so, List:
3/28/05 Page 3 of 4
Revie yr lu vornplure the following
YIN
PCMITtod as:
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Inspector Name & Date:
Notes
3128/05 Page 4 of 4