HomeMy WebLinkAboutCLE200500328 Action Letter 2017-08-03Application for Zoning Clearance t
f OFFICE USE ONLY�,,yn �y
Zoning Clearance = $35(/� CLE # ip 3a
PLEASE REVIEW ALL 3 SHE TS Check # 117 3 Date: 1 Z - ZCJ-D 5_
Receipt # Stuff,
PARCEL INFORMATION
Tax Map and Parcel: 056 Q - Of -- 0 D j i4 Q Existing Zoning
Parcel Owner: A kt of a t4+g. �..��++�- • L
Parcel Address:�5 % ? 3 'rA e— J (j ugea City 6V O 7-4 State V4 Zip 3
----------- ----
include - suite -or -floor
--------------------------------
pRTMARY CONTACT
Who should we call/write concerning this project? Fes. 94 a t.1 es'- a-V .
Address • G R State !/ Zip P-.-k
Office Phone: l + a ,q;"3 -q 6W— #
-------------------
PROJECT INFORWTION
Business Name/Type: e
Previous Business on this site:
Proposed use:
,-a ✓L -F
Circle (if applicable): Fireworks / Christmas Tree
iF # E-mail
-------------------------------------------------� k���.
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 ` � Printed S F • 2
------------------------------------------------------------------------------------------------------------------------------------------------
AP
/PROVAL INFORMATION
LN Approved as proposed [ ] Approved with conditions
[ ] Backflow 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 determination of compliance with the existing
site plan.
[ ] This site complies with the site plan as of this date.
977-4511, x 119
Date
Date
Cher Official Da�t/e
------------------------------- ------ --- __-�--_- r -r6-klaf---------------------------------------------------
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5532 Fax: (434) 972-4126 10/14/05 Page 2 of 4
Intake to complete the following:
Applicant to complete the following:
N
o you have one of the following?
Tax Map and Parcel Number and or;
Address of use (include unit or floor if appropriate;
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.
onirts! Tee to cornalete the fallowin
VADI-I�i[i �uas:
Y /'
If so, rst:
Yarwace:
Y lDIfs L'
Y I(ON
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
IQY N A PP
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
Y
Is p 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?
I
Y N
ill you be putting up a new sign of any kind? If so, obtain
proper Sign permit.
Permit # W
I
Y/N
ill there be any new construction or renovations?
If so, obtain the proper Permit.
Permit # ?z,- 6-3 tO-7 Or
Y N oq ow,r
Is this for sales of Fireworks?
If so, obtain a copy of FIR permit.
Permit #
If
Ifs , st:
S
YI
Ifs (St:
10/14/05 Page 3 of 4
Reviewtr to complete the rollosvioj::
squaw f'oomge nrUse-
SbW SF-'
Under Section: 1
Supplementary regulations section:
jPark L[1L:lbrlllkllB= S- ~ l /OdA 2z sxs �e R4 A,--tA.sy��j
Required spa �s: 3S �v I ( vVe4 l r Of5i I" ' r � � `�_ W
�l � NAOUK+Y Ls In VcZW {1vc [� GLr z�0u
Y /(
Items to be verified in the field:
Inspector Name & Date:
Notes
10 1 4..'05 Pa-* 4 of 4