HomeMy WebLinkAboutCLE200600144 Applicationqt 17 !ip
Application for Zoning Clearance
OFFICE USE ONLY n -
)Zoning Clearance = $35 CLE # l' o
PLEASE REVIEW ALL 3 SHEETS Check # Date:
Receipt # Staff:_
PARCEL INFORMATION
Tax Map and Parcel:
Parcel
Existing Zoning LZ
Parcel Address: 0% w Z & Ai �w— City 1 State Zip W/,
(include suiteorfloor) _________ - _________
PRIMARY CONTACT _ / G e > _ _
Who should we call/write concerning this project? /.t�CS G� S
Address : Q ?City �CJ/GGtate Zip
Office Phone: zu Cell # ax # aStIP �Ll7 // E -mail
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PROJECT INFORMATION
Business Name/Type:
Previous Business on this site:
use: %f // G
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. editions of approval, and I understand them, and that I will abide by them.
Signature Printed k/ �J �L ✓� L��% -�- j
- - - - - -- ------------------------------------------------------------------------------------------------ - - - - -- -
APPROVAL INFORMATION Backilow Device and/or
[ ] Approved as proposed [ . ] Approved with conditions Current Test Data heeded
[ ] Backflow device and/or current test data needed for this site. Contact ACSA 977 -4511, x119. Contact ACSA 977 -4$11, x 119
[ ] 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 witl�, the ite plan as o t is date. /�,,„,
i.- AA�,n, �ra�.ceC- :2Q�vr.A nn 1 xA 01 �1 `,ur L►�ayl�'l7l, r a, 611 zltlikii'V53VImaoz)
Building Official A Date to a
Zoning Official /� 1"J 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