HomeMy WebLinkAboutCLE200700032 Legacy Document 2013-05-22(Ice cty-
Application for
Zoning Clearance
toning Clearance = $35
REVIEW ALL 3 SHEETS
I �<y IN�P
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Tax map and parcel: �rT`� blj°e4a! ,` 42 n /v � 6C 1 � �LP� x rglZo ing: � au '� (_. o M Ii}/
Parcel Owner: a0' �/`a E C E C u ✓�� % U, �O; i� r,
Parcel Address: �� ,� —70 , City State Zip
(include suite or floor)
Contact Person (Who should we call /write concerning this project ?): �*� ��` U (� a E0
� f
Address 2► �a' My / �� e �% City State rl%a— Zip
Daytime Phone (7s y) 9-7 3 9- I Fax # L_)
DELL- 2, 27T6 -- 4 Z yh
E -mail
Business Name /Type: I? Gt1 J-27 0 i
Previous Business on this site: ■r A;: 14 C=
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 Bus' ess Owner or Agent. Date ,
A,,a_a n d Q�A- sllf'- —
Print Name -� ��,1 �'
qD"5 % -F4- ✓ rki M 0 Ir - to �j c�u u� I Ctr
APDPROVAL INFORMATION
[✓] Approved as proposed [ ] Approved with conditions
Backflow DMc.e and/or
ckflow device and/or current test data needed for this site. Contact ACSA 977 -4511, x119. Current Test Data Needed
[ • No physical site inspection has been done for this clearance. Therefore, it is not a determination of compli P,�fioaOtah m�
[ ] This site complies with the site plan as of this date.
Building Official
Date I -
Zoning Official IJWRM
Date
Other Official
Date
FOR OFFICE USE ONLY CLE # r / !!''�✓
Fee Amount �� Date Paid'Z_5..0•7 By who? Receipt # (D 30 C0 0/q60 Q By: C4
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