HomeMy WebLinkAboutCLE200500175 Action Letter 2017-08-01—ram Albemarle County Department of Community Development
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Fee of $35.00 Fife #44CV6
Application for Check# go?933 _ Date:
,honing Clearance 'ecept# 10z?3 _ Staff
Tax Map/Parcel: 1�o- z '2 D 0 2O 0
roParcel Owner:— A •
4 Address _,MKSeK % 44!5'
(Include suite or floor)
City ll�State Zip
Existing Zoning: e A l
Who should we calVwt'Ite concerning this project? / r`f/�
w Address s���a�� �� City ��/ `State Zip
n '! a � Office Phone: _ Cell: 't� Ol Liz
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Fax: I 3 7 �L" �/E-mail: C ram. GOAja
Business Name/Type:
Previous Business on this site: M4 Jai / 1� —
Proposed use:
Z22S/ 2 5
•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
Gearance will be required,
I hereby certify that I own or have the ownees 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 conditions of approval, and I understand them, and that I will abide by them.
Signature PrintedMr o✓
.............
------.-- Approved as proposed - - 05!pkpprovedWth conditions -------------•,••••------------
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Building Official Date osz
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Zoning Official Date 6124115
Applicant to complete the following:
;/ N Do you have one of the following:
Tax Map and Parcel Number and or;
Address of use (include unit or floor if appropriate;
JI N Do you have a Floor Plan (sketch or an architectural drawing) that includes the following:
Y 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.
i
;intake to complete the following:
Y / NN 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� Is parcel on private well and septic? If so, give applicant a Health Department form.
e Zoning review can not begin until we receive approval from Health Dept.
Y N Is on public water and sewer?
ON
Will you be putting up a new sign of any.kind? If so, obtain proper Sign permit.
Permit #
Will there be any new construction or renovations? If so; obtain the proper Permit.
Permit #
Y N 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---If—so, List: — _ - - - -
Proffers: Y / N If so, List:
Variance: Y / N If so, List:
SP's Y / N If so, List:
Reviewer to complete the following: Square footage of Use:
ej 1 N. Permitted as: Under Section
Supplementary regulations section:
formula:
Y /6? Items to be verified in the field:
Inspector Name & Date:
uired