HomeMy WebLinkAboutCLE200500308 Action Letter 2017-08-03DEC. 1. 2a05 11, 27AM KI RKLANDS Lisp, -731962P. 2qhN0���/
Application for Zoning Clearance
OFFICE USE ONLY
�oning Clearance = $35 CLE # &E
PLEASE REVIEW ALL 3 SHEETS • Check # in I-nT Date:
Receipt # S SUM
ZARCEL MORMATION JZ -1_- os-
ilax Mnp and lPa7rcel 1•� T ExiStbg Zotdn
Parcel Owner:
Parcel Address: ,J 6jv Zr t,& City %D , State VJ} Zip
(incluaesukcorxloor)....,..............»-------------------»----........_. ».»+...»..-------------...........
t t �PRIlMARY CONTACT
Who should we call/writc ncernin, g this project? r'CS C
Address : D5 !y Y Ctity�f j L' &O A-) State I ZIP —.Iffx%9&
Office Phone: P—b660 Ga Cell # 701-43VL- Fax
............................................. .................... . ... . ... . ... .............................. . .. .. ..........
PROJECT INFORMA.TXON ,
Pre4ous Business on this site: /V
_ Proposed use:
Circle (if applicable): Fireworks / Christmas Tree
SEE COA'DXTXONS OF APPROVAL 1F THE CLEARANCE XS FOR FIREWORK OR CMUSTMAS TREE SALES (Sheet 1)
*This Clearance will only be valid on the pawl for which it is eppro'ved, if you change, intensify or move the use to a new lowdoin, anew Zoning
Clearance wW be r+ecluhed.
I hereby cer[i�y That I own or have the owaefs permission to use the space ix4cated on this application. I also certify drat the information provided is
tnre and wauate to the best f 1mo dge. I have read the conditions of approval, and I understand them, and that I vaU abide by them. � L
Sig amre Printed"Z�
------------------------------».__....»...».... __......».»--------------- --- ........... ...,..-..---------------•----._._..-----------
ROVAL XNFORNIATION �
11) Approved as proposed `/1 Approved with conditions
[ ] Baeklow 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 detcnminarion of co existing
site plats. DVice andlox
[ ] This site complies with the site plan as ofthis date. ggco Test Dam Needed10
Other Official Date
»--------------------- -----� -r. ----� ----------------------- --- --
County of Melmarle Dewtment of Comm.ikaity Development
401 McIntire Road CharlottesviXle, VA 22902 Voice: (434) 29"832 Fax: (434) 977A126
10/14/05 Page 2 of
DEC, 1.2005 11,27AM KIRKLANDS
M 962
Intake to complete the following.
A,ppUcant to complete the Mowing:
OoN
you have one of the following?
Tax Map and Parcel Number and or;
Address of use (include unit or floor if ap ropriate;
(�/ N
]Do you have a Floor plan (dwtch or an mrbiteetural drowiing) that
includes the following, aDdif 0 please provide it with the
application? &' cBio(4.
The total square footage ofthe use and/or;
The square footage of Bach room or area of use;
Use of each room or urea
If using less thaw the entite structure, note the location vviffiW the
structure.
% Tech to
Viol =
Y /
If so, st
the
so, List:
�� �• 2 -1-061 -- -
Q ow- C>'vl -
Y
Is usW IvI, HI or PI3IP zoning?
Engineer's Report (CM pgdket-
If so, give applicant a Certified
X l
wall ere be food preparation?
If so, give applicarrt a Health Depar4a wW form.,
Zoning review can not begin until we receive approval from
Health Dept, FAX DATE
Y
Is 1 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
Y N
on public vaft and sewer?
;N
dill you be putting up a new sign of any kind? If so, obtain
proper Siga permit
]Permit #
VN
There be any new construction or renovatiow?
If so, obtain the p Permit
permit 0 a66•'AF�
Y ,,(N 53q� W
Is this for sales of Fireworks?
If so, obtain a copy of FIR permit,
Permit #
On
ra-111-4 -
F �&T IF a�
N
. List
10/14/45 Page 3 of 4
DEC. 1.2005 11:27AM KIRKLANDS NO.962 P. 4
l c r to co�opide duo rou
, _
gtMM face or use:
Y/N �`
Peru-Atted as: ,
Lhidu Sactioo �� � - 2--� %. • `1� � 1
SuppkrnentZ[q regOhliOaS 9EC401CL:
Fs4dug o�! Zww Cam-
Mgtlxrad s wm-.
Y/N V
[toms to be verificd in the ficld�
infpr"or Name & DaIP;
N ous
IVI1-#M YBBL+i JOI'I