HomeMy WebLinkAboutCLE200900139 Review Comments Zoning Clearance 2009-08-27Application for Zo Clearance-
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-.- -Zoning Clearance= $35 --
OFFICE USE ONLY
Check # 21 eS Date: °G ✓C
PLEASE REVIEW ALL 3 SHEETS
Receipt # ? C-% Staff: d ME
PARCEL INFORMATION , /G
Tax Map and Parcel: 07$OO ' 00 -00 Existing Zoning
_Farcel-Owner a 5 �d- r- �s.ls✓ i�a •-Z) - - - - --
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Parcel Address .P /� �.. 14, City l,J I ' �- State l/ p� Zip M47
(include suite or floor)
PRIMARY CONTACT
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_Who should we call /write concerning this project? y 19�t�✓ if
Address : Z's 7 w•ex y4o • 1�-ci • City NOl�'F -y' State - - 0. •- Zip
Office Phone: (_)�J�' Cell # \- Fax # E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type:
Previous Business on this site �Q.y►n.•f.
Describe the proposed business including se, number of employees, number of shifts, vailabl p rking space , number of
p y g �y1Tp ' � 01A t--
Y provide:
vehicles and an additional information that you can -+�
*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 'ha e the owner's permission to use the space indicated on this application. I also certify that the information provided
is true and accurate t e est of m knowledge. I have read the conditions of approval, an understand them, and that I will abide by them.
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:
p
Building Official Date
Zoning Official Date Z-7 / 1
Other Official Date
Pr
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401 McIntire Road Charlottesville; VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 04/28/08 Page 2 of 3