HomeMy WebLinkAboutCLE200700056 Legacy Document 2013-07-10Application for
Zoning Clearance
Zoning Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
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_ �RGIN� P
Tax map and parcel: 0q-6 C-0 —0 2"-06 — 00/ d 0 Existing Zoning: HLt) ^ f Ca yM r-T )
Parcel Owner: 40 6j f �/
XI / 47—/w
Parcel Address: /8 9J 5�rn4)e /r- ��i� City �bA__Tz!/' /�Cl State f� Zip 2 2 `7f3
(include suite or floor)
Contact Person (Who should we call /write concerning this project.): (ZA4),�h21T/ �
Address `� 6f ✓n %/U�l /&- 22W City 6i7fj e6#r5 �f ��� State _Zip Z 2 ��(9
Daytime Phone 7'J Fax # L___j
Business Name /Type: �/J
Pr ous Business on this site: Aa %�%�rw
Proposed use: Z'1!2 � /Wq S11atV)zaJ 4
E -mail
SEE CONDITIONS OF APPROVAL IF THE CLEARANCE IS FOR FIREWORK OR CHRISTMAS TREE SALES (Sheet 1)
Circle (if applicable): Fireworks / Christmas Tree
*This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move the use to a new location, a
new Zoning Clearance will be required.
I hereby certify that I own or have the owner's permission to use the space indicated on this application. I also certify that the information
provided is true and accurate to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will
abide by them.
Signature of B ness Owner or Agent
Print Name -J
APPROVAL INFORMATION
[VTApproved as proposed
Date '
[ ] Approved with conditions
Backflow Device and /or
Current Test Data Needed
: ontact ACSA 977 -4511, x l I"
[kJ Backflow device and /or current test data needed for this site. Contact ACSA 977 -4511, x119.
[vf i-4o physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing site plan.
[ ] This site complies with the site plan as of this date.
Building Official Date Z =�
Zoning Official Date
_
Other Official Date i
FOR OFFICE USE LY CLE Z Q %"
Fee Amount$, � Date Paid a y who? receipt (1--,Ck# y:
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