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ALBEMARLE COUNTY, VIRGINIA
CERTIFICATE OF OCCUPANCY
Zoning Permit No. /e/1/ ,7/4 Date of Application `" a Z - 22
When structure has been completed and this certificate has been filled out, return to:
PLANNING & ZONING OFFICE
COUNTY OFFICE BUILDING
COURT SQUARE
CHARLOTTESVILLE, VIRGINIA 22901
Note: Before Returning, Fill in Actual Cost and Sign Name or Corporation
The undersigned owner or lessee hereby applies for a certificate of occupancy in accordance with the pro-
visions of the Zoning Ordinance, for the following use, for the hereinafter described building, and hereby
agrees to fully conform to all the terms of any permit which may be issued on account of the application.
It is understood that this Certificate of Occupancy does not take the place of any license that may be re-
q u i red by law, and also that it does not confer the right to install or erect any kind of signs, boilers,
motors, or machinery.
‘1,12_1,1
Name of Owner
Address of Building /e 6c_?/ c51L i 76r
Tax Map g9 Parcel Zone —/
Proposed Use l2/
Material of Building Number of Stories
Address to which Certificate is to be mailed /e
/6/
Actual Cost
Remarks
This certificate will be issued to the applicant after construction has been completed and the structure
made ready for occupancy in the manner stated above.
date Signature of Owner or Lessee
Approved/Disapproved by
Zoning Administrator