HomeMy WebLinkAboutCLE200700010 Legacy Document 2013-05-22Application for=u�y�
Zoning Clearance
U Zoning Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
Tax map and parcel: Existing Zoning:'
Parcel Owner:
Parcel Address: 6n city State Zip�� -b/
(include suite or floor)
Contact Person (Who should we call /write concerning this project ?):
Address % ��J— ,-�S /c��c� 1eo.A.n City State �14- Zip
Daytime Phone (�/j 925--3104-3 Fax # _D 175 - -36- SS` 9-RMH- z 2 z 6
Business Name /Type:
Previous Business on this site: f✓� <G S /34 Z �Y �-L Z� L
Proposed use: ,r c c).1�) /�! ?.a•C�= r �t�� %r Ur 2= �� ✓%
SEE CONDITIONS OF APPROVAL IF THE CLEARANCE IS FOR FIREWORK OR CHRISTMAS TREE SALES (Sheet 1)
Circle (if applicable): Fireworks / Christmas Tree
*This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move the use to a new location, a
new Zoning Clearance will be required.
I hereby certify that I own or have the owner's permission to use the space indicated on this application. I also certify that the information
provided is true and accurate to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will
abide by them.
r
%--el -7
Signature of Business Ownei or Agent Date
Print Name
VAL INFORMATION
,ed as proposed
[ ] Approved with conditions
[ 1 j Backflow device and/or current test data needed for this site. Contact ACSA 977 -4511, x119.
[ ] No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing site plan.
[ V] This site complies with the site plan as of this date.
Building Official _ Date i l ::)
Zoning Official Date xlej _
Other Official Date
FOR OFFICE USE ONLY CLE # 7 —/(11)
Fee Amount$ q,6r01) Date Paid 1p 42'LBywho? SntP_a.dzy dZt'l Receipt #43, 73 Ck# _By: 6k Q.
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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