HomeMy WebLinkAboutCLE200700040 Legacy Document 2013-05-28Tax map and I
Parcel Owner:
Parcel Addres
Application for
Zoning Clearance
❑ Zoning Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
OF A "C1
��RO�N1h
Contact Person (Who should wercall /write concerning this project ?): K j (', /jI I v,':;' 01
Address ?t 0O ��r�mAy LYl City � I� V 1 /��? State _ Zip�2 -10 /
Daytime Phone &V- Fax # 1/-,,,1Q8 f E -mail
Business Name /Type:
Previous Business on this site:
Proposed use: e- e J
SEE CONDITIONS OF APPROVAL IF THE CLEARANCE IS FOR FIREWORK OR CHRISTMAS TREE SALES (Sheet 1)
Circle (if applicable): Fireworks / Christmas Tree
*This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move the use to a new location, a
new Zoning Clearance will be required.
I hereby certify that I own or have the owner's permission to use the space indicated on this application. I also certify that the information
provided is true and accurate to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will
abide by them.
Si ature of Business Owner 6r Agent Date
Print Name
APPRRWAL INFORMATION
[- bAfproved as proposed
[ ] Approved with conditions
] Backflow device and /or current test data needed for this site. Contact ACSA 977 -4511, x119.
] No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing site plan.
] This site complies with the site plan as of this date.
Building Official �— Date `1
Zoning Official Date lov D
Other Official Date
FOR OFFICE USEONLY C �E #
Fee Amount &—: 5 • U Date Paid2 •I& •01$y who? 'r Receipt # f �l7 � Ckt; 7 Q . By: nW
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