HomeMy WebLinkAboutCLE200700053 Legacy Document 2013-07-10Application for
Zoning Clearance
[n Zoning Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
Tax map and parcel: -j � �� Existing Zoning:
�z
� %RCIN�P
Parcel Owner: rr ���
Parcel Address: Y� �g �V �d l T )'7 h C� city._ e_)n u / b �S yji /zState Zip
(include suite or floor)
Contact Person (Who should we call /write concerning this project ?): .Ire �'r,-,-1)
Address ' T) JW 4� 5 0- 6ai,4- City
Daytime Phone c�i �5 j O Fax # (: ___3
E -mail
Business Name /Type: 5�6 to 2,u & d�-- OJ/\Q L � h lkS U11 i 1 �e
Previous Business on this site:
Proposed use:
M
State Zip
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.
of Bust e s 0,&r or A7ent / Date
Print Name
APPROVAL INFORMATION
[ ] Approved 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
Zoning Official Date
Other Official Date
FOR OFFICE USE ONLY � �^�T CLE # ---,2007- 53 r
Fee Amount $�_ Date Paid By who? � LT Receipt # 6 yy�s Ck By: C �•1
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