HomeMy WebLinkAboutCLE200500189 Action Letter 2017-08-01v
Albemarle County Depart,',,_ fit` of Community Development
EXHIBIT D
Fee of $35.OG File #:
Application for Check# Date:
Zoning Clearance Recept# Staff:
Tax Map/Parcel: 0139 6 0 d 0 040-- 0 4/30 0
Parcel Owner: 9:2_L2�4�t�Yrt�of� _ ^
(L ,o Address lae w J' Aity &4EQZ2 State G Zip c2AM,
(Include suite r or) c
Sefije_ Y t)Existing Zoning: ML
............................. .......................................................................................................
Who should we call/write concerning this project? G
Address ��� �t City f State n Zip C20I S f
Office Phone: �i�=�jZ � 3 Cell:
Fax: � 3 �.�/ ` l� 2 E-mail: , a ca- d /Ql r: t'�s 1,5r`ife &J S
Business Name/Type: V�P�'��..ffl�c�'S
Previous Business on this site:
Proposed use:
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 new Zoning
Clearance will be required.
I hereby certify that I own or have the owner's permission to use the space indicated on this application. I also certify that the information provided
is true and accurate to the best of m knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signaturez Printed L7 6710SID5
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( } Approved as proposed ( pproved with conditions
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Building
Date k \ -y `
Date j
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Zoning Official
Applicant to complete the following:
0, p, Do you have one of the following:
Tax Njap and Parcel Number and or;
Address of use (include unit or floor if appropriate;
Cl/ N Do you have a Floor Plan (sketch or ar. 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 Li, H! or PDIP zoning? if so, give applicant a Certified Engineer's Retort (CER) packet.
Y f 4"Jill 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 /� 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.
& N Is on pubilc water and sewer?
6/ N Will you be putting up a new sign of any kind? If so, obtain proper Sign permit.
Permit #
0 / N Will there be any new construction or renovations?? If so', obtain the prcper Permit. �Q(OC7
py4j��
Permit # ] .&09A UbkOf) � �"WT
Y ,CIs this for sales of Fireworks? if so, obtain a copy of F/R permit.
Permit #
Zoning Tech to complete the following:
Violations: Y 1 N if so, List: VID zi-132
Proffers: Y ! N If so, List:
Variance: Y f N If so, List:-
SP's Y ! N if so, List: "SF-2004.0 S T.DCh�DDS z
Reviewer to complete the following: Square footage of Use:
Q� •I l "> ZZ • 2- L
D
Y / N Permitted as: 1xt4U� S
Under Section:
Supplementary-regulatkms`saction:.
Reauired spaces: 329 5PCWS
Y / N Items fo be veriiiediFi iYi'ttt"-
Inspector Name & Date: