HomeMy WebLinkAboutCLE200900113 Review Comments Zoning Clearance 2009-08-24hcation for Zonn Clearance_-
" Zoning Clearance = $35
OFFICE USE ONLY n
Check # i Q 7 S Date: 1 -13-o
PLEASE REVIEW ALL 3 SHEETS
t Recei P #`I Staff:
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PARCEL INFORMATION
Tax Map and Parcel: %L�I�y%C(i p Agree 110 Existing Zoning /7(..-
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Parcel - Owner: — -ice t?/a— i/ �Fhi t�t/l S � fit2�i i, -J. /I V ef 14W•
Parcel Address: YY0 LA,e 4100 City 6/'0 %c f State UA Zip ZY63
(include suite or floor)
PRIMARY CONTACT
Ny U' �ff
Who should we call/write concerning this project?
Address-:---
ddress : 107Z %ViAerIrQe^ Ae City C4#,4&&rV,'1 %e State V4 Zip 22y03
Office Phone: ( L; y) 8Z3 IZ91/ Cell # 5 61 Fax # -- E -mail MAXbeeei.. dds CP Y*400eCa, ^
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name k New business
Business Name /Type: GPne ra l "&v�tt A. ny ae, Q1)s, /)l C"
Previous Business on this site none
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: o%�w, I)f cb?e, i e.r pbyees, / sA;,0 �%. d-o - Fri ),
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pbrti'�5 S�letes (?Vt osoeafeot wim, /Slue )u SAW,,.
*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 knowledge. I have read the conditions of approval,, understand them, and that I will abide by them.
�andI
Signature !/(. / �/l /y/ _ Printed /J w , - 4. / YAX4ee- ;
AJ�PROVAL 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 sited lies with the site plan as of this date.
Notes:_ _
Building Official A Date
Zoning Official a�f
Date /
Other Official Date
County of Albemarle Department 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