HomeMy WebLinkAboutCLE200600119 Legacy Document 2014-07-22' Application for Zoning Clearance�l
�ning Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY ?X f_
CLE # Uf W
Check # C"A Date:
Receipt # Staff: ,4 ;
PARCEL INFORMATION
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Tax Map and Parcel: O 41 t X I (166 Q el 6 r2 0 Existing Zoning Pu lJ
Parcel Owner:
Parcel Address: 41106 D2. city 0Aak1d a ✓, / /e: State Zip o� 2901
(include suite or floor) ------------------
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PRIMARY CONTACT .
Who should we call/write concerning this project? e' 11'GG25c' 'J,2. K% SS-A.47
Address: �� �cn %3 � � CityChtgrd) l/f- State V09- Zip,Q,? 16 C
Office Phone: (L6 Cell- 45, 0 Cell # Fax # OV 9V-0 y3 E -mail i e fF r Vet. <z�L,4 f • SC -spa C01—
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PROJECT INFORMATION
Business Name/Type: r v,+iH',V c �� s2i2yy CASnanlc� r L L('_
Previous Business on this site:
Proposed use:
Circle (if applicable): Fireworks / Christmas Tree
SEE CONDITIONS OF APPROVAL IF THE CLEARANCE IS FOR FIREWORK 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 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 knowled e. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature / �_� Printed J J _1,e
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APPROVAL INFORMATION Current Test Data Needed
[ 01 Approved as proposed [ ] Approved with conditions .intact ACSA 977 -011, X 119
[ ] Backflow device and/or current test data needed for this site.
[ ] No physical site inspection has been done for this clearance.
site plan.
[ ] This site complies with the site plan as of this date.
Contact ACSA 977 -4511, x119.
Therefore, it is not a determination of compliance with the existing
Building Official Date,
ro�l�,ofF,
Zoning Official Date
Other Official Date
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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 10/14/05 Page 2 of 4
Reviewer to complete the following:
Square footage of Use: l U O
/ N �Lb
Permitted as: a
Under Section: �6 • . o�-�i �. U
Supplementary regulations section:
Parking formula: 1 a 0 a1 60 l i
Required spaces:
Y/N
Items to be verified in the field:
Inspector Name & Date:
Notes .
10/14/05 Page 4 of 4