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Home My WebLink AboutCLE200900115 Review Comments Zoning Clearance 2009-08-28Application for_ Zones Clearance o =�® - KZoning Clearance = $35 - PLEASE REVIEW -ALL 3 SHEETS OFFICE USE ONLY Check # 605rA Date: f Receipt # -J' - Staff: PARCEL INFORMATION j s Tax Map and Parcel: 6 �/ / Existing Zoning`�C` Parcel Address: / Na ✓ �' City A /iJ � ��1 State Vii Zip (include suite or floor) PRIMARY CONTACT �-j��,� Who should we call/write concerning this project? /G Address : /�/�7/ (� City f�(/J� State t/ Zip L Office Phone: ( 4Z Well # Fax # E -mail APPLICANT INFORMA N Check any that apply: Change of owneershiipp Change of use Change of name New business Business Name /Type: `s ✓ t` Previous Business on this site /I 5ml _ eiylv 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: *This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move the use to anew location, anew 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, and I understand them, and that I will abide by them. ,, / A Signature r l '—. - Printed AP OVAL INFORMATION r. [ 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 sitmplies with the site plan as of this date. Notes: Building Official Date Zoning Official 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 IN