HomeMy WebLinkAboutCLE200500069 Action Letter 2017-08-01Albemarle County Department of Community Development
Fee of $35.QQ File PQQL5' I
Application for Check# n,�, Date:•-d
Zoning Clearance Recept# o`1-7 Staff:
Tax Map/Parcel: CC'7 r,) CC -0 Q 555Y d
e
Q Parcel Owner: Sn0 W QY
Address _ A V On city � i7�iateeZip z-290
(Include suite or floor)
Existing Zoning:
.-------------------------------------------------------------------------------------------------------------------------------------
Who should we call/write concerning this project?!
c c Address 1 -)v o \ � � C~i City '-v 1 �-� Zip z z [�
�a
n i "o - DO
4 Office Phone: - Cell:
R _
Fax: 00 - VIE L1725 E-mail: d e-w'PL[
---------------------•----------.....--------------...........-----------------------------------------------------------------------
0
c
4
Business Name/Type:
Previous Business on this site: �SM Shi Y �Q J e1&2•1,
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 witi be required.
I hereby certify that I own or have the owner's permission to use the space indicated on this appkadon. I also certify that the information provided
is true and accurate to best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Slgnatur Printed �
...._ .pproved as prop.........................................
sed ...........................� i.);Appr.........................................................
ved with conditions -•----•--------•-----•-----
e Duke =111111ow
0
to
current
Contact
aBuilding Official Date t
Date
Zoning Official Q
Applicant to complete the following:
r•
Y 1 N Do you have one of the followin§:
Tax Map and Parcel Number and or;
Address of use (include unit or floor if appropriate;
UY 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:
G1 N Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER).packet.
Y IUD✓ 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 10 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.
CY) 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 1� Will there be any new construction or renovations? If so; obtain the proper Permit.
Permit #
Y 16 Is this for sales of Fireworks? If so, obtain a copy of FIR permit.
�1 Permit #
Zoning Tech to complete the following:
Violations: Y 1 N
Proffers: Y 1
Variance: Y 1
If so, List:
If so, List:
If so, List:
If so, List: " 4 i "TV I U' 46
Reviewer to complete the following: Square footage of Use:
YIN
SP's OY 1 N
Items to be verified in the field:
inspector Name & Date:
IM