HomeMy WebLinkAboutCLE200500008 Action Letter 2017-07-31Albemarle County Department of Community Development
Fee of $35.00 Fie #: CAWL��
Application for Check'# , Date:
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Zoning Clearance Recept# staN
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Tax Map/Parcel: N5 Jn �i�� 00 0 AL-z
Parcel Owner: J
a Address City State Zip
(Include suite or floor)
Existing Zoning:
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Who should we call/write conceming this project? AA
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4 Office Phone: g75 14 2D Cell:
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Fax: l 75 2- E-mail: / ra 4&OM6 9
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Business Name/Type:
Previous Business on this site:
Proposed use:
Circle (if applicable): Fireworks / Christmas Tree
*This Clearance will only be valid on the parcel far 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 owners 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 4Z.99::��Printed .124 - C . 1 ,'�re�_
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( } Approvt s proposed °► roved with conditions
Building Official Date
Zoning Official Date
Applicant to complete the following:
Y I 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 1 N Do you have a Floor Plan (sketch or an architecture drawing) that includes the following:
The total square footage of the use and/or;
The square footage of each room or area of use;
Use of each room orarea
If using less than the entire structure, note the location within the structure.
,Jntake to complete the following:
Y I N Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet.
Y I N - 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.
Y I (N i 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.
OY1 N Is on public water and sewer?
Y I ND Will you be putting up a new sign of any kind? If so, obtain proper Sign permit.
Permit #
Y IUN Will there 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 FIR permit.
Permit #
Zoning Tech to complete the following:
Violations: Y 1 If so, List:
Proffers: Y 1 If so, List:
Variance: Y I If so, List: _
SP's Y /r If so, List: `
Reviewer to complete the following: Square footage of. Use:
Y I N Permitted as:
Under Section: JYjr3 � 1 -
Supplementary regulations section:
Parking formula: Required spaces:
Y 1 N Items to be verified in the field:
Inspector Name & Date: