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HomeMy WebLinkAboutCLE200700059 Legacy Document 2013-07-10Application for Zoning Clearance Eezoning Clearance = $35 PLEASE REVIEW ALL 3 SHEETS GIA, Tax map and parcel: J Existing Zoning: 1�0 Parcel Owner: /V Q PC-,o (2 C�. S �Je �►' �C� Parcel Address: `'l"•"1 )(V V)an I( -old- City ffi4 1 C -ad6f� State i � Zip (include suite or floor) Contact Person (Who should we call /write concerning this project ?): i'1 no- aLt-acti IJ Address a 3 , City o l State VQ Zip ��✓ Daytime Phone l��Zl 4-65-22-6Y Fax # �� E -mail claC a r�,Ccn ltng • ne+ Business Name /Type: n ee— zkai= Previous Business on this site: �� �.IL Proposed use: 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 ovided 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 p ride by them. ., of Business Print Name Date 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 CLE # ZOO % -' Fee Amount $36, oa Date Paid 3 — •`b By who? hhoi\► r i 1 f� Receipt it �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 of