HomeMy WebLinkAboutCLE200600135 Legacy Document 2014-07-24TO �'Vta-
Albemarle County Department of Community Development 2 00 M 13 5
.Application for
Zoning Clearance
Tax Map /Parcel:
Fee of $35.00
Check # g55G'' tt5
Recept # Lt
6600 - oo -Z)o - 0/L/ 0
File #:
Date: 5 "3 _016
Staff: _
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Parcel Owner:
a. ,o Address
i.�J/ Ciry tr�i� /G�.. late Zip��
(Include suite or floor) Existing Zoning:
Who should we call /write concerning this project? L:'���5 f `�
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?/l�r� J� City State Zip_.
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E -mail: v� <
Fax: ................. •--- •------------- •--- ....... -
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Business Name/Type: I , A43
Previous Business on this site:
Proposed use:
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*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. ace ndicated
I hereby certify that I own or have the owner's per have read the conditions of approval, and endlunderstand them, and that Ih will nab'tdeaby them.ld�
is true and accurate to the best of my knowledge.
Signature ...............................
.................... . •- - -.. --
•• -•- ...............................
" "' -" )Approve with conditions
............. n....rrw- cri -ac nfODOSed
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Building Official
� Date
Zoning Official
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App►'icant to complete the following:
Y/N
Do you have one of the following?
Tax Map and Parcel Number and or;
Address of use (include unit or floor if appropriate;
Y/N
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.
: oning Tech to com
Violations:
Y/N
If so, List:
Variance:
Y/N
If so, List:
the following:
Intake to complete the following:
Y /AO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /0
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 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
N
s on public water and sewer?
Y/NN
Will you be putting up a new sign of any kind? If so, obtain
proper Sign permit.
Permit #
Y
WillITTere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Y On
Is this or sales of Fireworks?
If so, obtain a copy of F/R permit.
Permit #
Proffers:
Y/N
If so, List:
SP's:
Y/N
If so, List:
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