HomeMy WebLinkAboutCLE200700072 Legacy Document 2013-07-10Application 1,
Zoning Clearance
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OFFICE USE ONLY •7_(00 -'7 — 7
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Zoning Clearance = $35
CLE #
Check # (93 Date:
PLEASE REVIEW ALL 3 SHEETS
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: _ 04500- 00 -068D2 Existing Zoning . Hgwy Comm
Parcel Owner:— Sams's Real Estate Business Trust
Parcel Address:_ 970 Hilton Heights Road City _ Charlottesville _ State _ VA Zip _22901_
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning'this project?
Address T,�-�rsm b . City CCl State V por Zip ��7iv3
Office Phone: ( 3q)979 -a5 do Cell # `7 21 - 519Cn Fax # 9'7 j QDO ( E -mail GCop2)�cl20( LiOr% �o�
APPLICANT INFORMATION
Business Name /Type: Fluvanna County High School Band Boosters
Previous Business on this site aC LZ
Describe the proposed business, including use, number of employees, number of shifts, available parking SP, and any ,
additional information that you can provide: Lj� �n
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*This Clearance will only he 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. 1 also certify that the information provided
is true and accu at to best of my knowledge. I have read the conditions of approval, and I understta/a��nd them, and that I will abide by them.
Signature Printed
APPRO AL INFORMATION
f/] Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device acid /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.
Notes:
Building Official Date
Zoning Official AA ,�/ Date ! // � o i
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
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