HomeMy WebLinkAboutCLE200900098 Review Comments Zoning Clearance 2009-06-25Application for Zoom Clearance
CLE#
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4zoning Clearance = $35
OFFICE USE ONLY
Check # �V f Date:
PLEASE REVIEW ALL 3 SHEETS
Receipt# 7a?77.ff Staff:
PARCEL INFORMATION
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Tax Map and Parcel: � xrsting Zoning a
Parcel Owner: S�(�'--�fa � �' t
Parcel Address:���� ��"��' �. City C e V State Zip
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project?
Address:.. �,� G ,✓., l�.-"
Cit y "4.: ti State
An-C Office Phone:
� P eII # Fax
, # E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type:
Previous Business on this site
Describe the proposed business including use, number of employees, nu, `tuber of shifts, available parking s aces, number of
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.
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I hereby certify that I own or have the owner's pennission to use the space indicated on this application. I also certify that the information provided
is true and accurate to the best of my kkedge I have read the conditions of approval and I understand them, and that I will abide by them.
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Signature °a --�� r,
—� Printed G w N0'_ ✓
APPROVAL INFORMATION
[ ] Approved as proposed [ J Approved with conditions Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, xl 19.
[ ] 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: 9'7��� -� �✓Lyg r;�Z,`'i d'ri i% ;� ��
Building Official Date - ,3
Zoning Official 4� ', T -��> Date �� ';A)
Other Official Date
t;ounry of Ainemarle luepartment of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 04/28/08 Page 2 of 3