HomeMy WebLinkAboutCLE200900097 Review Comments Zoning Clearance 2009-06-29_ Application for Zonn _ __Clearance
CLEF#
Zoning Clearance = $35
- -
OFFICE USE ONLY o
Check # 0001 Date: ��
7 Staff:
PLEA. REVIEW ALL 3 SHEETS
Receipt# .' C/ 4all,611
PARCEL INFORMATION • s�7
7 r Existing Zooming
Tax Map and Parcel:
Parcel_ - -,.
rj'c�t
Parcel Address: 120 f 5-ro^lzf y fib &,5 City (' (n c�, z;cri /Ax State p� /} Zip
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? Sf era � 1 G i!L�
Address: 1S1 1 OM TEA, C_ City rro / State \J ,A- Zip 2ZF3
Office Phone: L� Cell # ti ip Fax # E -mail
p5' 7J
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: u" K-9- Sji - 000Q_
Previous Business on this site 6��P® �`ie� i�`ir� ��l�� "-" /Ja'�'
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicles, and any additional information that you can provide: 2 -14 c ten[
*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 perniission to use the space indicated on this application. I also certify that the information provided
is true and accurate to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
- Signature - �-.,., _ Printed S,�i ev (.� �! i!r!_ J
e&,'�
APPROVAL INFORMATION
,,,J�49 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 - *° Date
Zoning Official �_ Date
Other Official Date
county of Amemarle iieparnment oz L;ommumty LeveivprneuL
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 04/28/08 Page 2 of 3
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