HomeMy WebLinkAboutCLE200500267 Action Letter 2017-08-03-Application for Zoning Clearance
OFFICE USE21 ,_,
❑ Zoning Clearance = S35 CLE #
Check # Date: !
PLEASE REVIEW ALL 3 SHEETS Receipt # Staff:
a 16-Iy-0C"
PARCEL M INFORAT
Tax Map and Parcel: Q� �(�� ! QQ Existing Zoning_
r
Parcel
Parcel Address: City State Zip
---(include suite or floor).............. -------------------------------- -- - ---
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APPLICANT INFORMATION ,
Who should we call/write concerning this project? lf a' ! -
Address: - ( d! +'S city ort un / _ State
zip
Office Phone: (d-y-) 2W Slot Cell # L o s 3y "I — Fax # 25L - ?SrS` E-mail 7- 01 .z&-. t�
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PRO-YF.r INFORMATynnj
Business Name/Type:
Previous Business on 1
Proposed use.- A �� W � . _ 0
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.
1 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 my knowledge- I have read the conditions of approval, and I understand them, and that I will abide by them.
X' �.
Signature` _ _ Printed *' ./,,t lc.- f 7r�s
APPROVAL INFORMATION
( ) Ap
Building Official Date IQ r r
Zoning Official Date _ A311-34pc
Other Official Date
...................... - -- --- - ...--L11-4'-... Lol.��'f_as.............................................
County of Albetharle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 9724126
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) mote the total square footage of the use;
c) Note the square footage of each room or area of use;
d) ':vote the use of each room or area of use.
Intake to complete the following:
Y IN Is the use in a LI, HI or PDIP zoning?
If so, give applicant a Certified Engineer's Report (CER) packet.
Cannot issue until CER is approved by the County Engineer.
P Will there be food preparation? �• ` -(i ��
If so, fax application to Health Department. FAX DATE
Can not issue until we receive approval from Health Dept.
Y I N 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 I N Is the parcel on public water and sewer?
YIN
Y!N
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.
Zoning Tech to complete the following:
Viol ns:
Y I N o If so, List:
Va ' ce:
Y If so, List
Reviewer to complete the following:
Square footage of Use:
Permit #
Protf:
Y 1 �� jj If so, List:
SP's:
Y ! N If so, List:
Permitted as:
Under Section: Supplementary regulations section:
Parking formula:
Y ! N Items to be verified in the field:
Required spaces: