HomeMy WebLinkAboutCLE200900130 Review Comments Zoning Clearance 2009-08-28... .. .... ... .
Application for Zoning Clearance_
AZ
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Clearance
OFFICE USE ONLY Q / / (�
Check # � 5 Date: V. O.0
Zoning = $35
PLEASE REVIEW ALL 3 SHEETS
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Receipt # '7&0aK Staff:
PARCEL INFORMATION i -
-7 P_ Existing Zoning��
Tax Map and Parcel: !�®
Parcel - Owner: 1 c - -- .1t� — r-
Z46 yc i c r Ci Lt 1i Zip 'z 2 11
Parcel Address: ty �rt� �� L�2 State
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project?
C�VLCAIr� .rl V Zip 2163
Address : (�e'G �la.l(4 �� City Oil�� State
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Office Phone: (� Ce 1 #` � "5 Fax # E -mail �l sue' �i ey lle,
APPLICANT INFORMATION
Check any that apply: Change of ownership Change- of use Change of name New business
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Business Name /Type: �t� Vz �. c'k Of
Previous Business on this site �+� s!!s�t�S4
Describe the proposed business including use, number of employees, number of shifts availableparking spaces, n tuber of
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vehicles, and any additional information that you can provide: "���fe�,
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*This Ll ar ce 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 a ura o 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_
APPROVAL 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 site complies with the site plan as of this date.
Notes:
Building Official Date
Zoning Official 1 Dated �/ ✓
Other Official Date
County of Albemarle impartment or t-:ommumty meveiopmem
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 04/28/08 Page 2 of 3
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