HomeMy WebLinkAboutCLE200500010 Action Letter 2017-07-31h Albemarle County Department of Community Development
9A o ' 6 t � _"` FA
Application for
Zoning Clearance
File #-.
Date:
staff.
Tax Map/Parcel:�sL�_��
c
m ' Parcel Owner: _ �/ �► �-++ U Lbw =x ► ��'�
4 � Address 144.5 tZto .Sut'fc- I Z. City CH-wA_c&eSf*U State 1 Zip L'1
s. (Include suite or floor)
Existing Zoning:
Fee of $35.00
Check # L71�) :.
Recept #
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Who should we calllwrite concerning this project? +L,,� C,-,,le,-r1rsS tL.,_ vw� 14
w« Address Vic, t2o,.vim .Q E & t te_
Office Phone:
Q w.
City rJbkQ Q6 ,,, tI State VA Zip Z?R V1
Cell:
Fax: E-mail: TL ON 6
c Business Name/Type: Lt r_,e-R4y 64�a4tcx
Previous Business on this site: 7
Z Proposed use:
a
Circle (if applicable): Fireworks 1 Christmas Tree
'This Clearance will only be valid on the parcel for which it is approved. If you change, Intensity 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. 1 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 1 A
..... ..... ...................................................................................................................
( Ap.proved.as proposed { ) Approved with conditions
ti -- Backtlow, Derma aa/or
Data Needled
2 p -4511,X119
aBuilding Official Date 1l o (fl
Q
Zoning Official Date
Applicant to complete the following:
CY) / 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:
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.
Intake to complete the following:
Y N Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet.
Y 1 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 N j 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.
1 N is on public water and sewer?
Y Will you be putting up a new sign of any kind? If so, obtain proper Sign permit.
Permit #
Y N ill there be any new construction or renovations? If so; obtain the proper Permit.
Permit #
1 N' Is this for sales of Fireworks? If so, obtain a copy of F!R permit.
Permit #
Zoning Tech to complete the following:
Violations: gY/ If so, List:
Proffers: If so, List:
Variance:If so, List:
SP's Y If so, List:
Reviewer to complete the following:
f r . r
iap�iler q� _C lations section:!
Parkina formulaAQare+Ow2O0W 14
45009• Ss 4200/� = (o
Y I N Items to be verified ih the field:
D
Inspector Name & Date:
9l-
Square footage of Use:
Under Section: 13.2• 1 1
ET Reauired saaces: 6 SPQGl