HomeMy WebLinkAboutCLE200500318 Action Letter 2017-08-03E�
Application for Zoning Clearance
OFFICE us ONLY
El Zoning Clearance = $35 CLE # S- 01 V
PLEASE REVIEW ALL 3 SHEETS Check # Date:
Receipt # 5 Staff.
PARCEL INFORMATION
Tax Map and Parcel: JDQM - co - 00 -09 7 C 0 Existing Zoning
Parcel Owner: 'L kif-a
Parcel Address: City State Zip
____ (include suite or floor) pp�1
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APPLICANT INFORMATION
Who should we call/write concerningthis project? 'c �Yl dl :t Lr-
Address :_-R i cl_2 ly, e e i* 5 V, 11e - )Cel city - r A z ; State _ t/A Zip s :%
Office Phone: C 7 - '-'4 Cell # Fax #-=;_-'.4- C -9 E-mail r j<t'Ys� ci Y1 " m.i✓! • �.
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PRIMARY CONTACT
Business Name/Type:i�.c Eri, �1 R,,,fi� �„✓ 477��1 �E' �, -
r• '
Previous Business on this site:!
Proposed use: s.�,� .,,' -- gas
Circle (if applicable): Fireworks / Christmas Tree
SEE CONDITIONS OF APPROVAL IF THE CLEARANCE IS FOR FIREWORK OR CHRISTMAS TREE SALES (Sheet I)
*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 '"ii ''fit► `` Printed .s=Jr,1E f' C:71'I
® i
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APPRO-- - ---VAL INFORMATION
[ 'A roved as proposed proved with conditions
[ o physical site inspection has been done for this clearance. `Therefore, it is not a determination of compliance with the existing
ite plan.
[ ] Thivite complies with the site Ian as of this date.
E���l>E'��1ti1:��''/.%1fil,+/�('/, �74f1 �ii�a��►1a'Tl!7111it13T.�il�
•� 11160
Z
I ii I i Date
Zoning Offici Date -4-,,
Other Official Date
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Couuty of Albemarle Department of Community 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:
C7/ N
Do you have one of the following?
Tax Map and Parcel Number and or;
Address of use (include unit or floor if appropriate;
q / N
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.
Soning Tech to
Violations:
YIN
If so, List:
ance:
Y N
L-fiso, List:
the
Intake to complete the following:
Y l(
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified I
Engineer's Report (CER) packet.
N
Will there be food preparation?
If so, give applicant a Health Department form. �o
Zoning review cannot begin until we rece' a ap roval from ` d`
Health Dept.
FAAX,,D�^ATE � ., � � ol- jYlpw-
��/ N ��r U�U . 1� )
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 q - ( �^06;
Y /O
Is on public water and sewer?
Y/P-)
Will you be putting up a new sign of any kind? If so, obtain
proper Sign permit.
Permit #
Y l
Will ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Yl
Is thi or sales of Fireworks?
If so, obtain a copy of F/R permit.
Permit #
Proffers:
YIN
If so, List:
's:
/N
so, List: � $ S -7 ��
4
4wri, ur io complete the fallnwino
S-,uare fDotege of Lim:
YIN
Permitted as;
Under Section:
Supplemfmtmy r%ula ons seutinn:
Parking farmulw
Required *Umg
Y/N
Itomm to be verified in the field:
Inspector Name & Dale -
Notes
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