HomeMy WebLinkAboutCLE200700012 Legacy Document 2013-05-22Application for '
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Zoning Clear4nce
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ping Clearance = $35
PLEASE REVIEW ALL 3 SHEETS ���/'`Q�
Tax map and parcel: Existing Zoning: p E)SC
Parcel Owner: Pa.
Parcel Address: City State Zip
(include suite or floor)
Contact Person (Who should we call /write concerning this project ?): O �, ��!'✓ (�. /' / /�.�✓i T, �'
Address ��T, 3 CN %) City o�� State s Zip
Daytime Phone (YJY 2 ,/� - y,5 Fax # 7-- 522d-E-mail 1 nf z
Business Name /Type: Z�C/� ✓ L z�w I
Previous Business on this site: /' r -
Proposed use:
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 them.
Signature of Business Owner or Agent Date/
Print Name
APtROVAL INFORMATION Backflow Device and/or
[ k]-Approved as proposed [ ] Approved with conditions Current Test Data Needed
Contact AC5A 9774511, x 119
BacHow device and/or current test data needed for this site. Contact ACSA 977 -4511, xl 19.
L;11Io 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.
Building Official
Date J
Zoning Official
Date
Other Official
Date
FOR OFFICE USE ONLY CLE �,(�/��
Fee Amount $3, x,00 Date Paid By who? Receipt # 3 Ck#, By:
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 of 4