HomeMy WebLinkAboutCLE200700037 ApplicationApplication for
ZoninLy Clearance
4zoning Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
i
Tax map and
Parcel Owner:
��RGIN�P
Parcel Address: ytZ �vk City State VA Zip 2Z .70,1
(include suite or floor) Pi j
Contact Person (Who should we call /write concerning this project ?): Al pli (� �
Address ( 7-1 6 feo+, d �7� �ay� &(ne. City C.1 fm) Ak State /VA Zip 2-Z14;,
Daytime Phone q7 ��1— ?� Fax # (__-) E -mail Giy ewe ICGV�IGtn Wtt�,c_, d^'+
Business Name /Type: ILcJUA►^ 9
Previous Business on this site: '1P iJ Sc7! l e V
SEE CONDITIONS OF APPROVAL IF THE CLEARANCE IS FOR FIREWORK OR CHRISTMAS TREE SALES (Sheet 1)
Circle (if applicable): Fireworks / Christmas Tree
*This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move the use to a new location, a
new Zoning Clearance will be required.
I hereby certify that I own or have the owner's permission to use the space indicated on this application. I also certify that the information
provided is true and accurate to the best of my.knowledge. I have read the conditions of approval, and I understand them, and that I will
abide by them.
Signa -e-o. Busi ess Owner or Agent Date
Print Name Backflow Device and /or
Current Test Data Needed
APPROVAL INFORMATION
[ ] Approved as proposed
[V/(Approved with conditions
X
] Backflow device and/or current test data needed for this site. Contact ACSA 977 -4511, x119.
] No physical site inspection has been done for this clearance. BTherefore, it is not a determination of compliance with the existing site plan.
] his �it�co �lie site pla�t date,
Building Official Date �$
Zoning Official Date ,3 0
Other Official Date
FOR OFFIC�LY LE #
Fee Amount $ Date Paid �By who? Receipt # �I1 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 of4