HomeMy WebLinkAboutCLE200500322 Action Letter 2017-08-03Application for Zoning Clearance
Oak
OFFICE USE ONLY
`Zoning Clearance = $35 CLE # LE- Z.0 0 5 3 Z 2—
PLEASE REVIEW ALL 3 SHEETS Check # _ Date: ---
Receipt#&Ly&jrj ':I Staff:
PARCEL INFORMATION /0 dd- sCk j° fV
Tax Map and Parcel: ����?G-0� �� - d�� Existing Zoning _ _
Parcel Owner: If 1-A e-f 2,1
Parcel Address: City e/�_,/r/r��l� State j/ Zip�D%
(inclue _floo)-----
............................ dsuiteor r
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APPLICANT INFORMATION ,
Who should we call/write concerning this project? / p �.�,�
Address :_ _j`�Jf" city State zip
Office Phone: (f7,1).3-?1d-kS— Cell # ✓ 7/� /� �6,I—Fax #703 ' ' "150s E-mail S"'109
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PRIMARY CONTAC,�/
Business Name/Type: r7- �7%J�. 's��/��' ��� � 'j� Z+�.iJ ej:s-
Previous Business on this site:
Proposed use: �ei2
Circle (if applicable): Fireworks / Christmas Tree Aj d G4
La.
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 ormove 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 _ _ _ _ Printed 70J6 J-'6 /'
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APYROVAL INFORMATION
[,Approved as proposed [ ] Approved with conditions
[ ] No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
site plan.
[ ] This site complies with the site plan as of this date. Backflow Device and/
Uurrent'lest DataNeeded
IC6ntaCtA 977-4511, x 119
Building Official Date �� /o �
Zoning Official Date r �(�
Other Official Date
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Coun 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:
YVN
Do you have one of the following?
Tax Ma and Parcel Number and or;
Address of use (include unit or floor if appropriate;
Y I N OW ry)0-00 iQ-00/ 6(P
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.
S'�gwnre 4-1 elw-0-2
Zonine Tech to complete the followin
Intake to complete the following:
Y
Is u LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Will there 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
/7111
Y
Is p el 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
on public water and sewer?
Y (N)
Wil you be putting up anew sign of any kind? If so, obtain
proper Sign permit.
Permit ##
Y
Will ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Y/N)
Is this for sales of Fireworks?
If so, obtain a copy of F/R permit.
Permit ##
Vio s:
Pro .
YIN
YIN
If s t:
If s .
Vari ce:
Y /
SP'
Y N
If so, t:
If s
Reviewer to complete the following: � ADO
Square footage of lJse: 1
9/28/ i Pave 9 of 4
Y I N
Permitted as:
Under Section:
Sapp3ementary regulndons section: -----
Parking formula: 'lq7 S F Iced— Z , i u6ew S// t 64 = $
(z v 7-
Required spaces: aGGS :A
YIN
licros #o be verIfled in the Feld:
Inspcctar Marne & Dale:
Notes
328M Page 4 of 4