HomeMy WebLinkAboutCLE200700055 Legacy Document 2013-07-10Application for
Zoning Clearance
�oningClearance = $35
PLEASE REVIEW ALL 3 SHEETS
Tax map and parcel: 0 J (0 � I � 6- 60 ~ � 0 2.0 U
� OF AI.BfI
I�fIOIN�P
Existing Zoning: P /D�' I c Iy
Parcel Owner: /; TY) s ) '! / L4./ =Vo
r a
Parcel Address: '15 �f— /i"L.` -/1 � it, E� 1?/J j �-� State
I d 't n
Zip Zz93
(mc u e sup a or oor)
Contact Person (Who should we call /write concerning this project ?): l_0 Lk-
Address Address 3c� r 4 ✓ � �S e- City State (( Zip
Daytime Phone 43A 01 q711 Fax# 3t !�%7 �/7 E -mail Gf1�L.(�U.ae My�tMQ�Q[°v ✓-c- LCv!
Business Name /Type: �n� rYY1e.,R /'o-r, �]�lC_
Previous Business on this site: n ofyq_
SEE CONDITIONS OF APPROVAL IF THE CLEARANCE IS FOR FIREWORK OR CHRISTMAS TREE SALES (Sheet 1)
Circle (if applicable): Fireworks / Christmas Tree
*This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move the use to a new location, a
new Zoning Clearance will be required.
I hereby certify that I own or have the owner's permission to use the space indicated on this application. I also certify that the information
provided is true and accurate to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will
abide by them.
S' n re o usiness er or A pt Date ,
a
Print Name
APPROVAL INFORMATION
[ ] Approved as proposed
[ ] Approved with conditions
] Backflow device and /or current test data needed for this site. Contact ACSA 977 -4511, x119.
] No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing site plan.
] This site complies with the site plan as of this date.
Building Official �-
Zoning Official
Other Official
Date
Date
Date
FOR OFFICE U$E ONLY CLE # ,?00"T -15
Fee Amount $ C,O� Date Paid ° l °D y By who? �, ��) Receipt # q�I (0 Ck# —T� 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 of 4