HomeMy WebLinkAboutCLE200900101 Review Comments Zoning Clearance 2009-07-06county OI AlDemarle 1JeparL11M1L vi %,viuuXUUXLy L111 F........
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 04/28/08 Page 2 of 3
Application for Zoning_ Clearance
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— CL # 6 -5 1�
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NAP
Zoning Clearance = $35
— OFFICE MTO Ly —�
Check # Date:
- - - —P- LEASE - REVIEW ALL 3 SLEETS__ _
Receipt # '' Staff:
i
PARCEL INFORMATION - �1
Tax Map and Parcel: t �oG V(l " Q ®� UO� Existing Zoning T
1'arceL03y_"r: Arm 6G:4/
_:_ _
�-P� City G e i /I'�1 Zip
Parcel Address: t( +-�fl
(Include suite or floor)
PRIMARY CONTACT
Who should we (call/write concerning this project?
to Uy`� Zip
Address 19 City (.Y1aTtJ,
Office Phone: (& & �.�'o� � ` Cell /(Fax # E -mail
APPLICANT INFORMATION
Check any that apply: of ownership Change of use Change of name New business
/Change
Business Name/Type:
Previous Business on this site
Describe the proposed business including use, number of employees, number of shifts, available arking spaces number of
vehicles, and ny additional information that you can provide:
*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
f dge. I have read the conditions of approval, and I understand them, and I will abide by them.
is true and accurate to th b t my w that
Signature Printed
APPROVAL INFORMATION
[ ] 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 i �� Date
Zoning Official Date d
Other Official Date
county OI AlDemarle 1JeparL11M1L vi %,viuuXUUXLy L111 F........
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 04/28/08 Page 2 of 3