HomeMy WebLinkAboutCLE200500206 Action Letter 2017-08-02Application for Zoning Clearance
❑ Zoning Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
PARCEL INFORi
Tax Map and Parcel:
Parcel Owner
Parcel Address:
-------------------------
OFFICE USE
&NV�,
CLE #
Check # Date:
Receipt # Staff:
nclude suite or floor__ ---------
-------------------------------------------
Existing Zoning P 10 ff—
State
APPLICANT INFORMATION
Who should we caWwririte c�oJncernin this project?
: r f
City
dress State lapWCY
J
Office Phone: Ce l # " _S-0164kFa7r #Wi 411c�- E-mail
-------------------------------------------------------------------------------------------------------------------------------------------------
PROJECT INFORMATION
Business Name/Type:
Previous Business on this si :
Proposed use:
Circle (if applicable): Fireworks / Christmas Tree
SEE CONDITIONS OF APPROVAL IF THE CLEARANCE IS FOR FIREWORK OR CHRISTMAS TREE SALES (Sheet3)
"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 certi h ' 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 accu a the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature*. �W. A
.. Printed ' I ' IC ° ' ' 4 )'kI 4)
AP OVAL INFORMATION
( Approved as proposed }A5t+
( ) Approved with conditions
Building Official Date
Zoning Official Date S, j1 '? �65
Other Official
Date
FA
• - County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 9724126
3/3/2005 Page 2 of 3
Applicant MUST HAVE the following information to apply:
1) Tax Map and Parcel or Address with unit number or floor if appropriate.
2) A Floor Plan - either a sketch or an architectural drawing
a) If using less than the entire structure, note the location within the structure;
b) Note the total square footage of the use;
f c) Note the square footage of each room or. area of use;
v d) Note the use of each room or area of use.
Intake to complete the following:
Y /) Is the use in a LI, HI or PDIP zoning?
If so, give applicant a Certified Engineer's Report (CER) packet.
Can not issue until CER is approved by the County Engineer.
Y I (N i Will there be food preparation?
If so, fax application to Health Department. FAX DATE
Can not issue until we receive approval from Health Dept.
Y N 1 Is the parcel on private well and septic?
If so, fax application to Health Department. FAX DATE
Can not issue until we receive approval from Health Dept.
(Y YN Is the parcel on public water and sewer?
Y N Will you be putting up a new sign of any kind? �Y7
If so, obtain proper Sign permit. Permit # : ` - -
Y N . Will there be any new construction or renovations?
�If so, obtain the proper Permit. Permit #� t� _
Y �JN.Is this for sales of Fireworks?
If so, obtain a copy of FIR permit,
Zoning Tech to complete the following:
Violations:
Y / N If so, List:
Y / N If so, List
Reviewer to complete the following:
Permit #
Proffers:
Y I N If so, List:
SP's:
Y / N If so, List:
Square footage of Use: 00/ _ Permitted as: __ T
Under Section: _Z cA.7 _ Supplementary regulations section:
Parking formula: z;Al. Required spaces:
1.01
Y 1� Items to be verified in the field: g F