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HomeMy WebLinkAboutCLE200500307 Action Letter 2017-08-03Application for Zoning Clearance 0 OFFICE USE ONLY Zoning Clearance = $35 CLE # ,Z.e-)o 5 -- 003 a —7 PLEASE REVIEW ALL 3 SHEETS Check # 1 Q - [ Date: — —U 5 Receipt# :6-741 4 Staff; PARCEL INFORMATION (b / Z-3p . &5- + Tax Map and Parcel: 00 W d v ` 0 A ^ 00 5 00 Existing Zonin CO +Nl rn e 2 C'_ Parcel Owner: Parcel Address: 6 e e—City f tate �1 Zipc ---------------------------- include suite or floor TION APPLICANT INFORMA Who should we call/write concerning this project? / O Address: J Pa % �t� }'ice Dr City ,K4 $fit% State VA zipzWel Office Phone: l 78 DY-19-4S Cell # ff 7f Fax # E-mail -6-)Z18[o ------------------------------- 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 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 SWABWh d F& x Printed ----------------------------------- --- --- - A'PROVAL INFORMATION -- ---------------- -- -- --- ----- - ---------------- - [ Approved as proposed [ ] Approved with 'tions $acktlew Device AmOlt [ ] No physical site inspection has been done for this clearance. Therefore, it is not a de a 'sting site plan. [ ] This site complies with the site plan as of this date. Contact AC5A 97'i-4511, =119 Building Official Date ( l Q o G Zoning Official Date ©� Other Official Date LI County o Albe�IcDeparLienio leommu ity Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126 9/28/05 Page 2 of 4 Applicant to complete the following: Y Do ou have one of the following? Tax Map and Parcel Number and or; Address of use (include unit or floor if appropriate; Y/N Do 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. Intake to complete the following: Isl Is ukellm LI, HI or PDIP zoning? Engineer's Report (CER) packet. If so, give applicant a Certified Y nN Will 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 Isl Is pahlel 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 V N on public water and sewer? Y /f Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Y l Will ih ere be any new construction or renovations? If so, obtain the proper Permit. Permit # Y Is thi or sales of Fireworks? If so, obtain a copy of F/R permit. Permit # Zoning Tech to complete the following: � 4 *Z OW) N C® Yir s: roffers: Y/N If s: If so, List: 2- • 2 rrl A - 1 °i6'W - b3L i _ 2 t —_l qas'. his _Ada- 112DO a01 r ariance: so, List: Y N so, List: Yo r • 'iyJlr rilia* 00t. Reviewer to cotoplete the following - Square Square fbou age of Use- 3 of 4 Y{ Permitted as; ��(�YI Gx Oxco CC., $� f.�S Linder SeVion: Supplements y ma.ulations section; �ff �� Parking formula: o 326c) Y - 20 Required spaces: r Y A Iteois to be verified in the Reid: Inspector Dame & Date. Notes MUM Page 4 o f 4