HomeMy WebLinkAboutCLE200600091 Legacy Document 2014-07-16r
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Application for Zoning Clearance
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OFFICE S + LY
❑ Zoning Clearance = $35 CLE #
PLEASE REVIEW ALL 3 SHEETS Check # Date:
Receipt Staff.
PARCEL INFORMATION
Tax Map and Parcel:
Existing Zoning_) 1 "T)
Parcel Owner: I I !J I I ' f -
Parcel Address: ail'Ie City State Zip
- (include suite or floor)
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PRIMARY CONTACT �
Who should we call/write concerning this project? 1 A i I Le,
Address: P O 3U� City U1(p, State
VA-
Zip 2-2ROZ
Office Phone: L� °1 �' (off y� Celt# 02-S - O5g3 Fax # q-f4-512(, E -mail 6 J c,,-ec-,,j-f11U' 14 L- :' ,-+
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PROJECT INFORMATION
Business Name/Type:
Previous Business on this site: 0c4 —Foal
Proposed use:'`" w VI054" —l�P tS- r�'�to� R �u�_�.., h�" ;" �u►!tT<f/1.�
1A,1,va 5w ;A— -.. roar: P _r :.:n., v- (n t, A A V: u ( e r,,h', v, t
Circle (if applicable): Fireworks / Christmas Tree I
SEE CONDITIONS OF APPROVAL IF THE CLEARANCE OR TFIREWORK OR CHRISTMAS TREE SALES (Sheet 1)
*This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move the use to anew location, a new Zoning
Clearance will be required.
I hereby certify at I or have a wner's permission to use the space indicated on this application. I also certify that the information provided is
true and accura a to t e b +t of my owl dge-I ave read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printedt
APP RO - - -- - - ATION ----- ----------------------•--•-••----....------------------------------------------------------:----
VAL INFORM
Approved as proposed [ ] Approved with conditions
[ ] B ckflow device and/or current test data needed for this site. Contact ACSA 977 -4511, x119.
o 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 C.
Zoning Official Date
Other Official Date
Co nty�emarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 10/14/05 Page 2 of 4
lU /14/UJ Page 4 oT 4