HomeMy WebLinkAboutCLE200900149 Review Comments Zoning Clearance 2009-09-11cation r one - aran-ce
ALE # 00 9- - -- -
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Zoning Clearance = $35
PLEASE REVIEW ALL 3 SFIEETS -
OFFICE USE ONLY
Check # 3 o 6i gam- Mate; _� 4
Receipt # 7_ta°
PARCEL INFORMATION `
Tax Map and Parcel: 43 �r � Existing Zoning 1. c, �7k{
Parcel Address: N—�n � ",z Ci ty �_ 4�t� State t " Zip ' :
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(include suite or floor)
PPJAIARY CONTACT g , g
Who should we call/write concerning this project? � �' i , �A� XrA
State
Office Phone: Cell E- mail \cte -t`ti@l$4t�a��se¢°�A^�
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type:�fl
Previous Business on this site°
Describe the proposed business including use, number of employees, number of shifts, available parldng spaces, number of
vehicles, and any additional information that you can provide-
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*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,, and I understand them, and that I will abide by them.
Signature Printed l—CXT' T-&4 ys& �c� a �
APPROVAL DWORMATION y
j.-T 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 Offici 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