HomeMy WebLinkAboutCLE200700074 Legacy Document 2013-07-10Application for
Zoning Clearance
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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 3
OFFICE USE ONLY
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❑ Zoning Clearance = $35
CLE #
Check # D 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? j RCL-- GLVZ
Address: �r�.�Q T� � DSO/] J. Y. LZ City rC�- State V for Zip PDf7
Office Phone: L4 979 -25 b0 Cell # Fax # 97 � - 6DO ( E -mail �icc:, 02dann( QQ7 C'O
APPLICANT INFORMATION
Business Name /Type: Fluvanna County High School Band Boosters
Car Lax
Previous Business on this site
Describe the proposed business, including use, number of employees, number of shifts, available parking s aces and any ,
additional information that you can provide: (. g _ ( ku QrjWQf,,r1,r-\r- ) rats 2.
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*This Clearance will only be valid on the parcel for winch it is approved. If you change, intensify or move the use to a new location, a new Zoning
Clearance will be required.
1 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 accu at to best of my knowledge. I have read the conditions of approval, and [ understand them, and dr/a/t I will abide by them.
Signature (�l Printed C rICt,_ (2w-e.lCtl1 -
APPRO AL INFORMATION
[]'Approved as proposed [ ] Approved with conditions [ ] Denied
Backflow prevention 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.
Notes:
Building Official Dates 1
Zoning Official Date Mzlt)
Other Official Date
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 3