HomeMy WebLinkAboutCLE200700033 Legacy Document 2013-05-22Application for _� °FA`''
Zoning Clearance- �,�,N,P '
❑ Zoning Clearance = $35 V-7 d _z2_3
PLEASE REVIEW ALL 3 SHEETS
Tax map and parcel: ftXi 2t= Existing Zoning:
Parcel Owner: ` r i n n
Parcel Address: N.f AA _,L(i! 1/]i City State Zip
(include suite or loor)
Contact Person (Who should we call/write concerning this project ?): ��ax fn rtafj 41tLLkic
Address (� J ( 17 � Qhn Of City. a �I t State Zip
Daytime Phone (18J 66 17 Fax # (�� E -mail
I-Z..:7 1 &d
Business Name /Type: p� C 0.� Pc
Previous Business on this site:
Proposed use:
SEE CONDITIONS OF APPROVAL IF THE CLEARANCE IS FOR FIREWORK OR CHRISTMAS TREE SALES (Sheet
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.
Si nature of Business Owner or Agent Date
Print Name
APPROVAL INFORMATION
[ ] Approved as proposed [,/1 Approved with conditions
4.50 15 (�
] 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.
] This site complies with the site plan as of this date.
Building Official
Zoning Official
Other Official
Date a -) --6�')
Date
Date
FOR OFFICE USE ONLY CLE # �(3 C� -7 _� �, 3 //�� C nn I�
Fee Amount $ Date Paid By who? .—A7 CL_ � Receipt # 1���� ,, Ck# (k--- 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 of4