HomeMy WebLinkAboutCLE200500058 Action Letter 2017-08-01Albemarle County Department of Community Development
Application for
Zoning Clearance
Tax Map/Parcel:
Parcel Owner:
a I Address ®fc
(Incl
.. 1 P V—
Fee of S35 00
Check # yI
Recept # l
Fie # S�
Date: CS) - Ei
staff: a kA
City a State f/fi Zip Q
or floor) g-
Existing Zoning:
...........................•----•---------------....----.....--------------...---------------...-- ------ ------------
Who should we call/write concerning this project? Ale
62 CD
Address ,0iak 7. City iG6LMd State Zip
ti m
`cL Office Phone: V4" I GZ _ Cell: ��Ll' e �r✓�J �
Q �
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0.
Fax:
Business NamelType:
Previous Business on this site: .
Proposed use: torl I V
cti
E-mail:
Circle (if applicable): Fireworks / Christmas Tree
'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 now Zoning
Clearance will be required.
I hereby certify that I own or have the owners parmi on to use the space indicated on this application. I also certify that the information provided
is true and accurate to be t f my knowledge. I ve read the conditions of approval, and I understand them, and at I will abide by them.
Signature r Print ' CMG
----•--•...........................................................................................................................
proved as proposed ( Approved with conditions
Building Official Date a.S
Zoning Official ------ Date Z3 0
Applicant to complete the following:
Y / N Do you have one of the following: g�r/.
T�tdlressof
rcel Number and
include unit or floorifppro pate;
fir"? �� Q I k!
Oy
N Do you have a Floor Plan (sketch oran architectural drawing)
tKat 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 structur , note the location within the structure.
Intake to complete the following:
Y lIN Is use in Li, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet.
Y ° 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.
f
Y 1 N 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 Y;9/ N Is on public water and sewer?
Y / N / Will you be putting up a new sign of any kind? If so, obtain proper Sign permit.
Permit #
Y I N Will there be any new construction or renovations? If so; obtain the proper Permit.
Permit #
Y YN Is this for sales of Fireworks? If so, obtain a copy of FIR permit.
Permit #
Zoning Tech to complete the following:
Violations: Y �/N) If so, List:
Proffers: �Y If so, List:
Variance: C
11 If so, List: ' YT
SP's Y / N If so, List:
Reviewer to complete the following:
�Y N Permitted as:
Supplementary
Parking formulft
Y 1(IV Items to be verged in the field:
Inspector Name & Date:
Square footage of Use:
Under Section: