HomeMy WebLinkAboutCLE200900055 Review Comments No Submittal Type Selected 2009-06-05r�S
�! p_plcaton for: Zonin_ _._Clearance
[Zoning Clearance = $35
OFFICE USE ONLY
Check # Date: '®
- -- PLEASE - REVIEW ALL 3- SIiEETS -- -
- Receipt # `% i Q ?a Staff:
PARCEL INFORMATION
2— Existing
Tax Map and Parcel: 9- 1 � Zoning
Parcel Address: L C`` ti i �� LcCfy 1N-State V J� Zip lzgc -
(include suite or floor)
PRIMARY CONTACT ,� d—j�
a'111 Q �A 2
Who?should we call /write concerning this project? ( cD (` f ti7 a1;1`� -�
pp { � i 'LVI
Address : t �"Lnl �r 4r� � � . �J � ` � 4 [`�,V City�i V1C C I , QJ\' � � � �. State � Zip
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Office Phone: �i( 1) �1-1i -O000 Cell # 4' ZL - `` 1."1-S`Nffax #4 %L1-q_19_4Li E -mail St�iGt-n6^av1 , �e- \Jz'nCJ0_I e-
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APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: �� �� btu d� � �� 1���� SOQco�i 1 S & C 04q
Previous Business on this site
Describe the proposed business including use, number of employees, number of shifts, a ailable parking spacesaa; -number of 1
{)� Q
vehicles, and any additional information that you can provider
*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 accu ate to y b� est�of my laiowledge. I have read the conditions of approval, annddjI understand them, and that I will abide by them.
Signature Printed \ Y \&A-vn 6Yt
APPROVAL INFORMATION
'V(Approved with conditions [ ] Denied
[ ] Approved as proposed [
[ ] 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 �orryplies wit the site plan as of this date.
Notes: ll��tt�� ,tc) l�(.� 1A
Building Official Date 3-
Zoning Official Date l 6 r1
Other Official Date
t -ounty oI Aloemarle 1JePa1 L111C11L V1 %_V111111UU1Ly iJ F
McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 04/28/08 Page 2 of 3