HomeMy WebLinkAboutCLE200700017 Legacy Document 2013-05-22Application for_` °,�''
Zoning Clearance
ning Clearance = $35
PLE REVIEW ALL 3 SHEETS
Tax map and parcel: ] -1.1 iN %v� 'D s7nn —z Existing Zoning:
Parcel Owner: 69X�,Ci? C0(n ^nUaJ i-V,—f C'..�tf jm tA-
Parcel Address: �`iCo'71l_a c� L +��L City COAAtVZ-a lyZfX—' State N/A Zip 22-9v/
(include suite or floor)
Contact Person (Who should we call /write concerning this projec (.fit /A_I' Wc1J
Address 3 is 1 MO L)r,: � L.,J City C IUu,e— State VA— Zip ZQ(
Daytime Phone L 3 qr1<;--75' 3C5 Fax # (�f) -79 —G} 3y9 E -mail Ja - coin
Business Name /Type: (fHjPCi+
Previous Business on this site:
Proposed use: C t4.(j g ,+
SEE CONDITIONS OF APPROVAL IF THE CLEARANCE IS FOR FIREWORK OR CHRISTMAS TREE SALES (Sheet 1)
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 my knowledge. I have read the conditions of approval, and I understand them, and that I will
abide by
-- X47jdtc-�
Signature of Business Owner or Agent Date
3,4 CD uJ) j CIJ �a t-3
Print Name
APPROVAL INFORMATION
[ ] Approved as proposed
Current Test Data Needed
[V/ Approved with conditions Contact ACSA 977 -4511, x 119
[1,fBackflow device and/or current test data needed for this site. Contact ACSA 977 -4511, x119.
[ ] No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing site plan.
[ ] This site complies with the site plan as of this date
SPa66L/-a 3 a watel .
Building Official �— Date y o
Zoning Official Date
Other Official '" 417 Date
FOR OFFICE USE ONLY CLE # 200-7 — / %
Fee Amount $35`,00 Date Paid j T:Q By who? r-(+ Receipt # 6,3731 Ck# Z-00'3 By: 5(2 Qr
So /;_, +fNCYL.,
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 5/1/06 Page 2 of4