HomeMy WebLinkAboutCLE200500038 Action Letter 2017-07-31Albemarle County Department of Community Development
Fee of $35 00 Fite#: C)C)C `S
Application for Chack# Q'-- Date: .
Zonin g Clearance Rece'# ! Staff: 1
Tax Map/Parcel: D 5M " c7 - ID() '_ oc,)]31CQ
•a° Parcel Owner: 160/`►�+� ✓�� �� `'r
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4 Address Itr- v l City +r.i State Zip a,2-201
Q (Include suite or floor)
Existing Zoning:
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Who should we call/write concerning thict? �Il� �� ni,S riY1• sk-L ry-t rvi 4 S
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Address /661 R City `tit State U1. Zip j2q0j
Office Phone: 413V - 7k- / 17 Cell:
Fax: ,(/JC/- l 7 3a 901' I E-mail:
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Business NameJType:
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Previous Business on this site:
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Proposed use: �r
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Circle (if applicable): Fireworks 1 Christmas Tree
'This Clearance will only be valid on the parcel for which It is approved. 9you change, intensify or move the use to a new kcatlon, 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 condth'ons of approval, and I understand them, and that I will abide by them.
Signature Printed J�r+ij
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( )Approved as proposed (�) Approved with conditions
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aBuilding Official Date 1A
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Zoning Official Date
Applicant to complete the following:
1 N Do you have one of the following:
Tax Map and Parcel Number and or;
Address of use (include unit or floor if appropriate;
0 1 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 Ll, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet.
Q/ N Wiil 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 /0 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.
O1 / N Is on public water and sewer?
Y 10 Will you be putting up a new sign of any kind? If so, obtain proper Sign permit.
Permit #
Y / Will there be any new construction or renovations? If so; obtain the proper Permit.
Permit #
Y /0 Is this for sales of Fireworks? If so, obtain a copy of F/R permit.
Permit #
Zoning Tech to complete the following:
Violations: Y /9N If so, List:
Proffers: Y / N If so, List:
Variance: /9 If so, List:
SP`s Y 1 If so, List:
Reviewer to complete the following: Square footage of Use:
0�)/ N Permitted as: 4V Under Section:
Supplementary regulations section:
Parking formula: Required spaces:
�1 N items to be verified in the field: y o••e�
Inspector Name & Date: