HomeMy WebLinkAboutCLE200500066 Action Letter 2017-08-01Albemarle County Department of Community Development
Fee of $35.00 Fie #. d b5 - d <. (p
Application for Check# r/ 3 . a09: 3-4-os
Zoning Clearance Recept# <<�►� Staff �14
Tax Map/Parcel: • j<? C{-ZjU 0 — p 0 ---0 0 CA�af 2Q
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roParcel Owner: 5 P
4 O Address r Qgd !pl t'(s [T_K_City Lip
r (Include suite or floor)
Existing Zoning:
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Who should we call/write concerning this project?
Address O'Ll, 0
Office Phone:
City �,It j5:W7 X State Zip
f
Cell:
Fax: C� E-mail: �',(JG{ ('_A)C XT
Business Namefrype:
Previous Business on this site: f _ Y fl— A / A/ 2, SUd
Proposed use:
Circle (if applicable): Fireworks 1 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 new Zoning
Clearance will be required. //��
I hereby certify that I own or have the�wners permission to use the space indicated on this appricadon. 1 also certify that the intormation 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 G''�rJ PrintedG
� Approved.as proposed---------X------- -- ( )Approved ditiolis .........................
r/ C":.,
Applicant to complete the following:
Y / Do you have one of the following:
Tax Map and Parcel Number and or;
Address of use (include unit or floor if appropriate;
(:YN 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 1 N 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.
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 N Is on public water and sewer?
7 Y N Will you be putting up a new sign of any kind? if so, obtain � �xrr��(�
proper Sign permit.
/
Permit# ra"
N Will there be any new construction or renovations? If so; obtain the proper Permit.
Permit # ele
Y IP Is this for sales of Fireworks? If so, obtain a copy of FIR permit.
Permit #
Zoning Tech to complete the following:
Violations: Y 1 N
Proffers: Y 1 N
Variance: Y 1 N
SP's Y 1 N
If so, List:
If so, List:
If so, List: d 4
-9
If so, List:
Reviewer to complete the following:
Y / N Permitted as: '
Supplementary regulations section:
formula:
Y Items to be verified in the field:
Inspector Name & Date:
Square footage of Use:
0.
A446 `i'
28 2005
L-PIA I l
Under Section: ; , Q , k -'--7 22.2. 1 b
3 -1- e on