HomeMy WebLinkAboutCLE200900129 Review Comments Zoning Clearance 2009-08-21—
Aimlieation for Zoning _Clearance -
Aw-
-
cL _ -
' Zoning Clearance = $35
OFFICE USE rY
Check # �� Date:
Receipt # tll Staff:
PLEAS VIEW ALL 3 SIIEETS
PARCEL INFORMATION
Tax Map and Parcel: (.G (O r O Existing Zoning !
Parcel Address:°!/ ����"��? �l City tate Zippy'
(include suite o • floor)
PRIMARY CONTACT
'
Who should we call/write concerning this project.
- ion
Address , Z�70• `' `/ �~ e � �a,� - - - -
`� ®�,� State V/ Zip
-City
Office Phone: (_� Cell #-70 3f G "t �7C� Fax # E- mail
APPLICANT INFORMATION
Check any that apply: of ownership Change of use Change of name New business
JChange
Business Name/Type:-�TP "�S�r�Ii! d��, PG
Previous Business on this site'iC�� %����
Describe the proposed business including use, number of employees, number of shifts, availa le parking spaces, number of
vehicles, and any additional information that you can provide:
*This Clearance wilf 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, and I understand them, and that I will abide by them.
Signature- _ ���-� Printed�li'f8•
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.
[ j This site complies with the site plan as ofthis date.
Notes"
Building Official e DateI�
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